Challenges in conducting community-driven research created by differing ways of talking and thinking about science: a researcher’s perspective

Increasingly, health scientists are becoming aware that research collaborations that include community partnerships can be an effective way to broaden the scope and enhance the impact of research aimed at improving public health. Such collaborations extend the reach of academic scientists by integrating a variety of perspectives and thus strengthening the applicability of the research. Communication challenges can arise, however, when attempting to address specific research questions in these collaborations. In particular, inconsistencies can exist between scientists and community members in the use and interpretation of words and other language features, particularly when conducting research with a biomedical component. Additional challenges arise from differing perceptions of the investigative process. There may be divergent perceptions about how research questions should and can be answered, and in expectations about requirements of research institutions and research timelines. From these differences, misunderstandings can occur about how the results will ultimately impact the community. These communication issues are particularly challenging when scientists and community members are from different ethnic and linguistic backgrounds that may widen the gap between ways of talking and thinking about science, further complicating the interactions and exchanges that are essential for effective joint research efforts. Community-driven research that aims to describe the burden of disease associated with Helicobacter pylori infection is currently underway in northern Aboriginal communities located in the Yukon and Northwest Territories, Canada, with the goal of identifying effective public health strategies for reducing health risks from this infection. This research links community representatives, faculty from various disciplines at the University of Alberta, as well as territorial health care practitioners and officials. This highly collaborative work will be used to illustrate, from a researcher’s perspective, some of the challenges of conducting public health research in teams comprising members with varying backgrounds. The consequences of these challenges will be outlined, and potential solutions will be offered

The Vital Role of Social Workers in Community Partnerships: The Alliance for Gay, Lesbian, Bisexual, Transgender and Questioning Youth

The account of The Alliance for Gay, Lesbian, Bisexual, Transgender, and Questioning (GLBTQ) Youth formation offers a model for developing com- munity-based partnerships. Based in a major urban area, this university-community collaboration was spearheaded by social workers who were responsible for its original conceptualization, for generating community support, and for eventual staffing, administration, direct service provision, and program evaluation design. This article presents the strategic development and evolution of this community- based service partnership, highlighting the roles of schools of social work, academics, and social work students in concert with community funders, practitioners and youth, in responding to the needs of a vulnerable population

Growth hormone secretion is correlated with neuromuscular innervation rather than motor neuron number in early-symptomatic male amyotrophic lateral sclerosis mice

GH deficiency is thought to be involved in the pathogenesis of amyotrophic lateral sclerosis (ALS). However, therapy with GH and/or IGF-I has not shown benefit. To gain a better understanding of the role of GH secretion in ALS pathogenesis, we assessed endogenous GH secretion in wild-type and hSOD1(G93A) mice throughout the course of ALS disease. Male wild-type and hSOD1(G93A) mice were studied at the presymptomatic, onset, and end stages of disease. To assess the pathological features of disease, we measured motor neuron number and neuromuscular innervation. We report that GH secretion profile varies at different stages of disease progression in hSOD1(G93A) mice; compared with age-matched controls, GH secretion is unchanged prior to the onset of disease symptoms, elevated at the onset of disease symptoms, and reduced at the end stage of disease. In hSOD1(G93A) mice at the onset of disease, GH secretion is positively correlated with the percentage of neuromuscular innervation but not with motor neuron number. Moreover, this occurs in parallel with an elevation in the expression of muscle IGF-I relative to controls. Our data imply that increased GH secretion at symptom onset may be an endogenous endocrine response to increase the local production of muscle IGF-I to stimulate reinnervation of muscle, but that in the latter stages of disease this response no longer occurs

How should studies using AI be reported? Lessons from a systematic review in cardiac MRI

Recent years have seen a dramatic increase in studies presenting artificial intelligence (AI) tools for cardiac imaging. Amongst these are AI tools that undertake segmentation of structures on cardiac MRI (CMR), an essential step in obtaining clinically relevant functional information. The quality of reporting of these studies carries significant implications for advancement of the field and the translation of AI tools to clinical practice. We recently undertook a systematic review to evaluate the quality of reporting of studies presenting automated approaches to segmentation in cardiac MRI (Alabed et al. 2022 Quality of reporting in AI cardiac MRI segmentation studies—a systematic review and recommendations for future studies. Frontiers in Cardiovascular Medicine 9:956811). 209 studies were assessed for compliance with the Checklist for AI in Medical Imaging (CLAIM), a framework for reporting. We found variable—and sometimes poor—quality of reporting and identified significant and frequently missing information in publications. Compliance with CLAIM was high for descriptions of models (100%, IQR 80%–100%), but lower than expected for descriptions of study design (71%, IQR 63–86%), datasets used in training and testing (63%, IQR 50%–67%) and model performance (60%, IQR 50%–70%). Here, we present a summary of our key findings, aimed at general readers who may not be experts in AI, and use them as a framework to discuss the factors determining quality of reporting, making recommendations for improving the reporting of research in this field. We aim to assist researchers in presenting their work and readers in their appraisal of evidence. Finally, we emphasise the need for close scrutiny of studies presenting AI tools, even in the face of the excitement surrounding AI in cardiac imaging

The reproducibility of manual RV/LV ratio measurement on CT pulmonary angiography

Objectives: Right ventricular (RV) dysfunction carries elevated risk in acute pulmonary embolism (PE). An increased ratio between the size of the right and left ventricles (RV/LV ratio) is a biomarker of RV dysfunction. This study evaluated the reproducibility of RV/LV ratio measurement on CT pulmonary angiography (CTPA). Methods: 20 inpatient CTPA scans performed to assess for acute PE were retrospectively identified from a tertiary UK centre. Each scan was evaluated by 14 radiologists who provided a qualitative overall opinion on the presence of RV dysfunction and measured the RV/LV ratio. Using a threshold of 1.0, the RV/LV ratio measurements were classified as positive (≥1.0) or negative (<1.0) for RV dysfunction. Interobserver agreement was quantified using the Fleiss κ and intraclass correlation coefficient (ICC). Results: Qualitative opinion of RV dysfunction showed weak agreement (κ = 0.42, 95% CI 0.37–0.46). The mean RV/LV ratio measurement for all cases was 1.28 ± 0.68 with significant variation between reporters (p < 0.001). Although agreement for RV/LV measurement was good (ICC = 0.83, 95% CI 0.73–0.91), categorisation of RV dysfunction according to RV/LV ratio measurements showed weak agreement (κ = 0.46, 95% CI 0.41–0.50). Conclusion: Both qualitative opinion and quantitative manual RV/LV ratio measurement show poor agreement for identifying RV dysfunction on CTPA. Advances in knowledge: Caution should be exerted if using manual RV/LV ratio measurements to inform clinical risk stratification and management decisions

CT scoring system to defined thrombus distribution in chronic thromboembolic pulmonary hypertension

Objectives Characterization of thrombus is important for guiding treatment in chronic thromboembolic pulmonary hypertension (CTEPH). This study presents a novel scoring system for visual assessment of CTEPH on CT pulmonary angiography (CTPA), incorporating both disease location and extent to determine the impact on survival outcomes. Methods Patients with CTEPH were identified retrospectively from the Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Centre registry. The scoring system emphasizes disease based on their predominant location as central, segmental, and distal disease. Survival analysis was conducted using Cox-regression and Kaplan–Meier survival curves. Results A total of 208 patients with CTEPH were included (mean age 66 ± 13.6 years, 52.4% female). Mosaic perfusion and infarction were commonly seen in patients with distal disease (92% and 88%). Patients with central and distal disease had more severe pulmonary hemodynamics and lower gas transfer (TLCO) than patients with segmental disease. Central and distal disease showed similar survival, whereas survival was worse in central compared to segmental disease for all patients (P < .001), including those undergoing (P < .04) and not undergoing endarterectomy (P < .001). Central disease was an independent predictor of mortality in those not undergoing endarterectomy (hazard ratio 1.9, P < .01). Conclusions Our scoring system showed excellent interobserver agreement. Thromboembolic disease location was shown to be a predictor of mortality, with central disease independently associated with shorter survival in patients not undergoing pulmonary endarterectomy. Advances in knowledge This is a novel scoring system for characterizing CTEPH on CTPA, considering disease location and extent. It provides disease location as a predictor of survival, introducing a new framework for patient stratification and clinical decision-making

Advancements in cardiac structures segmentation: a comprehensive systematic review of deep learning in CT imaging

Background Segmentation of cardiac structures is an important step in evaluation of the heart on imaging. There has been growing interest in how artificial intelligence (AI) methods—particularly deep learning (DL)—can be used to automate this process. Existing AI approaches to cardiac segmentation have mostly focused on cardiac MRI. This systematic review aimed to appraise the performance and quality of supervised DL tools for the segmentation of cardiac structures on CT. Methods Embase and Medline databases were searched to identify related studies from January 1, 2013 to December 4, 2023. Original research studies published in peer-reviewed journals after January 1, 2013 were eligible for inclusion if they presented supervised DL-based tools for the segmentation of cardiac structures and non-coronary great vessels on CT. The data extracted from eligible studies included information about cardiac structure(s) being segmented, study location, DL architectures and reported performance metrics such as the Dice similarity coefficient (DSC). The quality of the included studies was assessed using the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Results 18 studies published after 2020 were included. The DSC scores median achieved for the most commonly segmented structures were left atrium (0.88, IQR 0.83–0.91), left ventricle (0.91, IQR 0.89–0.94), left ventricle myocardium (0.83, IQR 0.82–0.92), right atrium (0.88, IQR 0.83–0.90), right ventricle (0.91, IQR 0.85–0.92), and pulmonary artery (0.92, IQR 0.87–0.93). Compliance of studies with CLAIM was variable. In particular, only 58% of studies showed compliance with dataset description criteria and most of the studies did not test or validate their models on external data (81%). Conclusion Supervised DL has been applied to the segmentation of various cardiac structures on CT. Most showed similar performance as measured by DSC values. Existing studies have been limited by the size and nature of the training datasets, inconsistent descriptions of ground truth annotations and lack of testing in external data or clinical settings. Systematic Review Registration: [www.crd.york.ac.uk/prospero/], PROSPERO [CRD42023431113]

Lung parenchymal and cardiac appearances on CTPA impact survival in chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is commonly evaluated using CT pulmonary angiography (CTPA). We evaluated the frequency and impact of parenchymal and cardiac abnormalities on survival in CTEPH. Methods Patients were identified from the ASPIRE (Assessing-the-Spectrum-of-Pulmonary-Hypertension-Identified-at-a-Referral-Centre) Registry. Kaplan-Meier analysis was used to assess survival. Results 290 patients (55% female, mean age 65±14 years) with CTEPH were included. Mosaic perfusion was noted in 83%, lung infarction in 73% and parenchymal lung disease in 28%. The severity of mosaic perfusion and lung infarction correlated with markers of disease severity (p<0.001). Whereas the presence of mosaic perfusion was associated with improved survival in all patients (p=0.03), it did not predict outcome in those undergoing pulmonary endarterectomy (PEA) (p=0.6) and those not undergoing PEA (p=0.22). The presence of lung infarction had no impact on mortality. The presence of co-existing lung disease was associated with a worse survival (p<0.008), in patients not undergoing PEA. Mosaic perfusion was less common in patients with parenchymal lung disease (65%) compared to those without parenchymal lung disease (90%), p<0.001. Increased right: left ventricular ratio and aortic diameter predicted worse outcome (p<0.002). Conclusion Lung parenchymal and cardiac changes on CTPA predict outcome in CTEPH. Co-existing parenchymal lung disease is not uncommon and when present may mask the presence of mosaic perfusion. This study highlights the importance of systematically evaluating the lung parenchyma and cardiac changes in patients with CTEPH

Pulmonary hypertension and the role of MRI flow assessment: a systematic review

Objectives Cardiac magnetic resonance imaging (CMR) plays an increasingly important role in non-invasive assessment of pulmonary hypertension (PH). This systematic review aimed to assess the utility, accuracy, and clinical applications of CMR flow techniques in evaluating pulmonary arterial blood flow in patients with suspected or confirmed PH. Methods MEDLINE and EMBASE databases were searched on December 10, 2024, utilizing the following key terms: “cardiac MRI,” “flow,” and “pulmonary hypertension.” Eligible studies were screened, and data extraction included study design, cohort characteristics, CMR flow techniques and outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale. Results Thirty-eight studies (mean sample size: 30 [20-57]) published between 2012 and 2024 were included. These utilized 2D flow (19 studies), 4D flow (15 studies), black blood imaging (1 study) and combined flow techniques (3 studies). Vortex duration derived by 4D flow demonstrated the strongest correlation (r = 0.96) with mean pulmonary artery pressure and the highest diagnostic accuracy in identifying PH patients (area under the curve, 0.99). Risk of bias rated 14 studies as good/very good and 13 as unsatisfactory, with none justifying their sample size selection. Conclusion CMR flow parameters correlate strongly with right heart catheterization measurements and demonstrate high diagnostic accuracy in identifying patients with PH, with 4D flow potentially adding greater value. This systematic review reinforces the potential benefit of CMR flow techniques in the investigation, prognostication, and monitoring of PH patients. Advances in knowledge This systematic review is the first to evaluate the role of CMR flow techniques in PH and should inform guidelines on flow assessment in PH