University Of Iowa Research Articles

Modeling the population-level impact of a third dose of MMR vaccine on a mumps outbreak at the University of Iowa

Mumps outbreaks among fully vaccinated young adults have raised questions about potential waning of immunity over time and need for a third dose of the measles, mumps, rubella (MMR) vaccine. However, there are currently limited data on real-life effectiveness of the third-dose MMR vaccine in preventing mumps. Here, we used a deterministic compartmental model to infer the effectiveness of the third-dose MMR vaccine in preventing mumps cases by analyzing the mumps outbreak that occurred at the University of Iowa between August 24, 2015, and May 13, 2016. The modeling approach further allowed us to evaluate the population-level impact of vaccination by different timing in relation to the start of the outbreak and varied coverage levels, and to account for potential sources of bias in estimating vaccine effectiveness. We found large uncertainty in vaccine effectiveness estimates; however, our models showed that early introduction of a third dose of MMR vaccine during a mumps outbreak can be effective in preventing transmission. School holidays, such as the winter break, likely played important roles in preventing mumps transmission.

Dietary questions in caries risk assessment and their relationship to caries.

This retrospective chart review evaluated the relationship between specific dietary questions used in caries risk assessment and planned restorative treatment among patients attending a dental school's clinic. Records for 6,218 adult patients attending the University of Iowa College of Dentistry who completed caries risk assessments and comprehensive oral examinations during 2018-2019 were included. The number of planned caries restorative treatments were compared between groups based on responses to specific dietary questions on the caries risk assessment. Analyses included chi-square and Wilcoxon rank-sum tests and logistic regression for factors associated with caries treatments. About 20% of subjects needed caries treatment, and regression analyses found that younger age, having unstructured meals, drinking sugared beverages daily, and drinking them for more than 30 min were significantly (p < 0.01) associated with having caries. Specific and focused questions on dietary practices are strongly associated with caries, and may be useful in improving caries risk assessments.

Intra- and interlimb effects of gait retraining in individuals with knee hyperextension

BackgroundGait retraining, which typically focuses on the most severely affected limb or joint, has shown promising results in treating faulty running and walking patterns. The closed-chain nature of gait during the stance phase may influence kinematic changes in the adjacent joints of the trained leg. In addition, the coupled nature of the lower extremity motion of gait suggests that changes in one leg may transfer to the other. This study aimed to assess the intra- and inter-limb transfer of kinematic changes following gait retraining to reduce knee extension in individuals with hyperextension walking patterns. MethodsSeventeen women with knee hyperextension gait patterns participated in six treadmill retraining sessions. All participants received verbal and real-time visual kinematic feedback in the form of knowledge of results. This intervention study took place at the Gait Analysis Laboratory at the University of Iowa. Mean peak sagittal-plane lower extremity joint kinematics during overground walking at pretraining, post-training, and 1- and 8-month follow-ups were calculated for analysis and comparisons. FindingsThe post-training changes in ankle range of motion returned to baseline values by the 8-month follow-up. There was a significant transfer effect of kinematic changes to the untrained knee following gait retraining. InterpretationTraining one knee did not result in long-term compensatory kinematic changes in the other joints. In addition, the improvements in knee extension range of motion were transferred to the untrained knee and retained at the 8-month follow-up. This study supports the use of gait retraining as an effective clinical intervention.

A fully adaptive time–frequency coupling model using self-attention mechanism based on deep operator network for very short-term forecasting of ship motion

Very short-term ship motion forecasting aims to predict future movements using historical ship motion data. While ship motion features both temporal and frequency characteristics, the latter is often neglected. This paper proposes a fully adaptive time–frequency coupling forecasting model using self-attention mechanism based on the Deep Operator Network (DeepONet), abbreviated as TFD. The multi-head attention layers enable the trunk net to adaptively learn the relationships between different frequencies in the frequency domain and assign varying weights accordingly. Thus, compared to the Fourier transform and multilayer perceptron-net enhance model based on DeepONet (FMD), which relies on manually specified filter frequencies, the TFD model is capable of fully learning the motion patterns in both the time and frequency domains, establishing nonlinear mapping relationships between them. It exhibits greater interpretability and generalization. The TFD model is tested for accuracy and generalization using ship motion data from the Iowa University experimental tank. The results indicate that, compared to the DeepONet and FMD, the TFD model reduces the mean square error (MSE) by up to 64.72% and 52.45%, with an average reduction of 55.57% and 42.47%. In terms of generalization, the forecasting MSE is reduced by up to 65.04% and 46.08%. Compared to the DeepONet and FMD, the proposed TFD model demonstrates significant improvements in forecasting horizon and generalization, providing a notable advantage in very short-term ship motion prediction applications.

Prevalence of Bronchodilator Responsiveness: A Comparison of Old Versus New Criteria.

In 2021, the European Respiratory Society (ERS)/American Thoracic Society (ATS) guidelines issued a new definition of bronchodilator responsiveness, which is now defined as an increase in FEV1 or FVC by ≥ 10% of the predicted FEV1 or FVC. The impact of this revised definition on bronchodilator responsiveness prevalence has been relatively understudied. We retrospectively analyzed data from 2,696 subjects who performed pulmonary function testing at the University of Iowa from 1997 to 2018. We compared the prevalence of bronchodilator responsiveness by using the 2005 (FEV1 or FVC increase ≥ 12% baseline value and ≥ 200 mL) and 2021 (FEV1 or FVC increase ≥ 200 mL and ≥ 12% of baseline value) ERS/ATS definitions, across several different respiratory diagnosis categories. We compared the prevalence of bronchodilator responsiveness using the 2 definitions by applying the McNemar test and assessed concordance of bronchodilator responsiveness by calculating kappa coefficients for the whole study population and within each diagnosis category. The prevalence of bronchodilator responsiveness increased from 9% when using the 2005 ERS/ATS definition to 16% when using the 2021 definition within the entire cohort and also within each respiratory diagnosis category. In the subjects with normal pre-bronchodilator spirometry, there was a low prevalence of bronchodilator responsiveness (3%) when using the 2005 definition, and the prevalence increased (8%) when using the 2021 definition. In the subjects with normal pre-bronchodilator spirometry and FEV1 Z score ≥ 0, 2% had bronchodilator responsivness according to the 2005 guidelines, whereas 7% had bronchodilator responsiveness according to the 2021 guidelines. The prevalence of bronchodilator responsiveness increased when using the new 2021 ERS/ATS definition compared with the 2005 definition. In the subjects with normal pre-bronchodilator spirometry, the prevalence of bronchodilator responsiveness increased when using the 2021 definition, in particular, among those with an FEV1 Z score ≥ 0, which raises concerns for overdiagnosis. Future investigations should examine the correlation of bronchodilator responsiveness with clinical outcomes in this group of subjects.

5 questions with Iowa's Shuchita Poddar

In our recurring “5 questions with” series, we profile a communications professional through a brief Q&amp;A. This month, we introduce you to Shuchita Poddar, communications coordinator for the office of admissions at University of Iowa.

5 questions with Iowa's Shuchita Poddar

In our recurring “5 questions with” series, we profile a communications professional through a brief Q&amp;A. This month, we introduce you to Shuchita Poddar, communications coordinator for the office of admissions at University of Iowa.

Data Mining Virtual Contaminated Sites to Develop an Educational Learning Tool supported by a k-NN Machine Learning Predictive Algorithm for use in Environmental Engineering Education

Recent work by Mumford et al. used high-resolution numerical simulations of contaminated sites to evaluate the state of practice for contaminated site investigation1. These simulations were originally developed in collaboration with academic and industry partners, including the U.S. Department of Defense's Environmental Security Technology Certification Program (ESTCP), as a training tool for environmental monitoring and performance optimization. This project focuses on the development of an algorithm to determine available borehole information in those simulations based on user-input, to help leverage this work to create an educational tool. The algorithm begins by validating user-specified coordinates to ensure they fall within an acceptable range. Leveraging principles from linear algebra and a grid-based mapping system, it identifies the nearest existing borehole on a predefined coordinate grid. To optimize efficiency, the algorithm utilizes a 2-D array to store and retrieve coordinate data. It calculates distances from the input coordinates to all available borehole locations on the grid, to identify the shortest distance and select the closest borehole, enabling students to map contamination within virtual sites. In addition to boreholes, the application incorporates data for Membrane Interface Probes (MIPs), monitoring wells, groundwater samples, and soil samples that are used to investigate contaminated sites, providing a comprehensive tool for training environmental professionals. The k-nearest neighbors (k-NN) algorithm predicts Membrane Interface Probe (MIP) Photoionization Detector (ECD) readings at future locations, which indicate chlorinated contaminant levels. Two models were evaluated: one using spatial data and ECD values, and another incorporating electrical conductivity (EC) and hydraulic conductivity (K), which are also measured by MIP. By making use of additional parameters, variations in soil properties were better represented, leading to more accurate predictions. Through iterative testing and refinement, the tool’s accuracy and user-interface have been enhanced, ensuring robust reliability for classroom applications. These tools are slated for integration into 4th-year subsurface contamination courses at Queen's University, Carleton, and the University of Iowa. By automating borehole selection, instructors can interact more with students and dedicate less time to data processing tasks. The k-NN application will enable the use of machine learning for site assessment to optimize MIP instrument placement to reduce bias. Assistance from Cole Van De Ven (Carleton University) and Jessica Meyer (University of Iowa) in collecting virtual contaminated site data is gratefully acknowledged.

Positive predictive value of administrative diagnosis codes, for all patient encounters in the electronic health record, to detect postoperative infections: Retrospective cohort study after cesarean delivery

BackgroundPrioritization of anesthetizing locations for infection prevention depends on having a high positive predictive value for the detection of postoperative infection (PPV). Our study goal was to estimate the PPV after cesarean birth using hospital's International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Because earlier studies had low PPV for infection from antibiotic medication administration records, if each prescription had a corresponding diagnosis code, infections must have been listed for presumptive diagnoses (e.g., redness), not literally infection. Our cohort of obstetrical patients was unique for scientific investigation in that the vast majority developing postoperative infection were evaluated postoperatively by the same (surgical) department. MethodsThe population studied were all patients undergoing cesarean delivery from October 2015 through March 2022 at the University of Iowa. The ICD-10-CM codes were obtained from any type of encounter in the health record (e.g., clinic visit or emergency room). The hospital's quality improvement daily surveillance program followed National Healthcare Safety Network (NHSN) definitions. ResultsThe 147 cases studied were 2.9 % of the 5006 cesarean deliveries performed. Every postoperative infection from the daily surveillance program was included among the 147 cases. There were 144 of these patients evaluated by an obstetrician on the date of the ICD-10 diagnosis code(s) detecting postoperative infection. The estimated positive predictive value was 99.3 % (143/144), lower 95 % confidence limit 96.8 %. ConclusionsTo optimize patient benefit and hospital return on investment, infection preventive measures should include operating room/specialty combinations with the most postoperative infections. Automated health record review is needed. Every ICD-10-CM code is based on a clinician's note and thus the clinician's specialty (department) is known from the hospital's diagnosis tables. Using diagnosis codes for 90-day postoperative infection from surgeons' notes, high positive predictive value can be obtained (e.g., for use by anesthesia departments).

Suchita Poddar on social media analytics

In our recurring “5 questions with” series, the Recruiting and Retaining Adult Learners marketing column profiles a communications professional through a brief Q&amp;A. This month, we introduce you to Suchita Poddar, communications coordinator for the office of admissions at University of Iowa.

Caitlin Clark's surprising economic impact

Increases in attendance for University of Iowa's women's basketball games caused by star player Caitlin Clark have led to claims of large economic benefits for Iowa City. This paper uses daily hotel occupancy data to analyze the visitor inflow arising from Clark's stardom. The findings show a surprising pattern: hotel occupancy did increase substantially during Clark's junior season but showed a much smaller increase during her senior season, even with considerably higher game attendance. Local fans substituting from men's games to women's games, thereby leaving fewer women's basketball seats available for out-of-town visitors, appears to explain at least some of the smaller hotel occupancy effect in Clark's senior season.

Q&amp;A: 5 questions with Shuchita Poddar

In our recurring “5 questions with” series, the Recruiting and Retaining Adult Learners marketing column, profiles a communications professional through a brief Q&amp;A. This month, we introduce you to Suchita Poddar, communications coordinator for the office of admissions at University of Iowa.

Sequential Endoluminal Gemcitabine and Cabazitaxel with Intravenous Pembrolizumab as a Bladder-Preserving Strategy for Docetaxel-Unresponsive Non-Muscle Invasive Urothelial Carcinoma Following Transurethral Resection of Bladder Tumor.

Growing evidence suggests that many patients with high-risk non-muscle invasive urothelial carcinoma (NMIUC) can undergo bladder-sparing management with salvage intravesical therapies. However, inherent or developed disease resistance, particularly after multiple lines of prior salvage therapy, implores the continued pursuit of new treatment combinations. Herein, we describe the outcomes of 26 patients (31 treated units; 24 lower tract, 7 upper tract) with high-risk NMIUC treated with sequential intravesical gemcitabine and cabazitaxel with concomitant intravenous pembrolizumab (GCP) at the University of Iowa from August 2020 to February 2023. Median (IQR) follow-up was 30 (IQR: 17-35) months. Treated units had a history of high-risk NMIUC with a median of four prior endoluminal inductions. Overall, 87% of units presented with CIS or positive urine cytology. The 1- and 2-year recurrence-free survival was 77% (CI: 58-88%) and 52% (CI: 30-70%), respectively. The 2-year progression-free and cancer-specific survival was 70% (CI: 44-85%) and 96% (CI: 75-99%), respectively. In total, 22/26 (85%) patients reported any adverse event and 5/26 (19%) reported a grade ≥3 adverse event; however, all patients tolerated a full induction course. These results suggest that GCP is an effective and tolerable treatment option for patients with recurrent high-risk NMIUC.

A Surgical Skills Rotation for Mid-Level Residents.

The University of Iowa orthopaedic residency previously designed a month-long surgical skill rotation for postgraduate year (PGY)-1 residents. This successful initiative has become a model of interest for other teaching institutions. In addition to the intern year, an important phase in residency occurs during the transition from PGY2 to PGY3, when residents assume greater responsibility and autonomy in leading surgical procedures. To directly address this transition and assess residents' readiness, our residency program established a week-long PGY2 surgical skills rotation. This rotation serves as a training checkpoint and focuses on both training and evaluation of level-appropriate skills in joint arthroplasty, trauma, arthroscopy, and wire navigation. The primary objective of the PGY2 surgical skills rotation is to enhance orthopaedic residents' operative skills and experience by providing increased exposure and practice of requisite technical skills. Similar to the Orthopedic In-Training Examinations that assess residents' knowledge, this week-long program, aimed at assessing residents' proficiency in fundamental orthopaedic technical skills, occurs before their PGY3 year. Faculty-led training and assessment sessions in each area offer residents many opportunities for dedicated practice and improvement. Transferring these acquired skills from the laboratory to the operating room is essential for a training program. To confirm improvement, the final day of the surgical skills rotation was exclusively dedicated to structured performance evaluations, with a specific emphasis on establishing proficiency benchmarks. We herein describe the University of Iowa's PGY2 surgical skills rotation, providing insights into its development, implementation, and outcomes. By sharing our experience, we offer a framework for other academic departments seeking to optimize surgical skills education and ensure the successful transition of mid-level residents.

Autologous Stem Cell Transplant in Fit Patients With Late Relapsed Diffuse Large B-Cell Lymphoma That Responded to Salvage Chemotherapy

The standard of care (SOC) for fit patients with relapsed diffuse large B-cell lymphoma (DLBCL) ≥12 months after completing frontline therapy is salvage chemotherapy (ST) followed by autologous stem cell transplant (ASCT). However, this strategy may not be optimal for patients with certain clinical characteristics. We retrospectively studied 151 patients with DLBCL that relapsed ≥12 months after R-CHOP or R-CHOP-like frontline therapy who underwent ST and ASCT at Mayo Clinic between July 2000 and December 2017 or the University of Iowa between April 2003 and April 2020. Clinical characteristics, treatment information, and outcome data were abstracted. Progression-free survival (PFS) and overall survival (OS) from the time of ASCT were analyzed using the Kaplan–Meier method. The median time from frontline therapy completion to 1st relapse was 26.9 months. The median line of ST was 1 (range 1–3), and 17 (11%) patients required >1 line of ST. Best response before ASCT was partial response (PR) in 60 (40%) and complete response (CR) in 91 (60%) patients. The median age at ASCT was 64 yr (range 19–78), and 36 (24%) patients were of ≥70 yr. The median follow-up after ASCT was 87.3 months. The median PFS and OS were 54.5 and 88.9 months, respectively. There was no significant difference in PFS and OS based on the age at ASCT (including patients aged ≥70–78 yr), sex, transplant era, time to relapse, LDH, extranodal site involvement, and central nervous system/nerve involvement at relapse. However, patients with advanced-stage relapse had inferior PFS than those with early-stage relapse (median 45.3 versus 124.7 months, P = .045). Patients who required > 1 line of ST, compared to those requiring 1 line, had significantly inferior PFS (median 6.1 versus 61.4 months, P < .0001) and OS (17.8 versus 111.7 months, P = .0004). There was no statistically significant difference in survival in patients who achieved PR versus CR, though numerically inferior in the former, with median PFS of 38.9 versus 59.3 months (P = .23) and median OS of 78.3 versus 111.7 months (P = .62). Patients achieving CR after 1 line of ST had excellent post-ASCT outcomes, with median PFS of 63.7 months. In conclusion, survival after ASCT was unfavorable in patients with late relapsed DLBCL (≥12 months) who required more than 1 line of ST to achieve PR or CR, and such patients should be treated with alternative therapies. Conversely, survival was favorable in patients who required only 1 line of ST, supporting the current clinical practice of ASCT consolidation in these patients. Moreover, outcomes were favorable in patients aged ≥70 to 78 yr at ASCT, similar to younger patients, highlighting the safety and feasibility of this approach in such patients.

Understanding Belonging at Work: A Case Study of the University of Iowa's Commitment to Employee Well-Being.

Understanding Belonging at Work: A Case Study of the University of Iowa's Commitment to Employee Well-Being.

A Multinational, Multi-Institutional Study Assessing the Impact of Diabetes Mellitus on the Prognosis of Patients with Non-Muscle Invasive Bladder Cancer Treated with Bacillus Calmette-Guérin

The study aimed to examine the impact of diabetes mellitus type 2 (DMII) on the oncological outcomes of non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) using comprehensive real-world data. We performed an analysis of data on NMIBC patients treated with BCG from the United States (US) National Phase II BCG/Interferon (IFN) trial database (125 centers) and pooled databases from three tertiary care institutions: France (FR), Lebanon (LB) (2000–2021), and the US (University of Iowa) (2011–2021). There were 867 patients from the Phase II trial, 1232 from the FR/LB cohort, and 233 from the US (Iowa) cohort (n = 2332). DM II was reported in 13% of the Phase II trial cohort, 14.4% of the FR/LB cohort, and 33.5% of the US (Iowa) cohort. The median follow-up was 24 months in the Phase II trial cohort, 25 months in the FR/LB cohort, and 48 months in the US (Iowa) cohort. In multivariable Cox regression analyses, DMII was not significantly associated with recurrence or progression of the tumor in any of the cohorts included in this study. DMII may not be a clinical prognostic factor for NMIBC patients treated with BCG. Prospective evaluation is needed.

Intravesical Gemcitabine and Docetaxel Therapy for BCG-Naïve Patients: A Promising Approach to Non-Muscle Invasive Bladder Cancer.

Bacillus Calmette-Guérin (BCG) therapy for patients with non-muscle invasive bladder cancer (NMIBC) faces limitations in efficacy and significant side effects, aggravated by a recent global shortage. In this prospective clinical study, we report the outcomes of sequential intravesical administration of gemcitabine and docetaxel (Gem/Doce) as a first-line treatment for BCG-naïve patients with high-risk NMIBC (HR NMIBC). From October 2019 until April 2022, we enrolled 52 patients and followed the treatment protocol set forth by the University of Iowa. Follow-up assessments were conducted every 3 months. In this cohort, 25 (48.1%) patients were diagnosed with high-grade T1 (T1HG) bladder cancer, 10 (19.2%) patients had carcinoma in situ (CIS), and 17 (32.7%) patients had a combination of T1HG+CIS. The median time to first recurrence in the T1HG, CIS, and T1HG+CIS groups was 11, 10.5, and 8.8 months, respectively. The recurrence-free survival was 98.1%, 94.2%, and 80.8% at 6, 9, and 12 months, respectively. The rate of progression-free survival was 100%, 98.1%, and 92.3% at 6, 9, and 12 months, respectively. We demonstrated the safety and efficacy of Gem/Doce therapy in BCG-naïve patients with HR NMIBC during a one-year follow-up. Further research with extended follow-ups, as well as direct comparisons of Gem/Doce with other anticancer agents, is essential.

A Hybrid Deep Spatiotemporal Attention‐Based Model for Parkinson's Disease Diagnosis Using Resting State EEG Signals

ABSTRACTParkinson's disease (PD), a severe and progressive neurological illness, affects millions of individuals worldwide. For effective treatment and management of PD, an accurate and early diagnosis is crucial. This study presents a deep learning‐based model for the diagnosis of PD using a resting state electroencephalogram (EEG) signal. The objective of the study is to develop an automated model that can extract complex hidden nonlinear features from EEG and demonstrate its generalizability on unseen data. The model is designed using a hybrid model, consisting of a convolutional neural network (CNN), bidirectional gated recurrent unit (Bi‐GRU), and attention mechanism. The proposed method is evaluated on three public datasets (UC San Diego, PRED‐CT, and University of Iowa [UI] dataset), with one dataset used for training and the other two for evaluation. The proposed model demonstrated remarkable performance, attaining high accuracy scores of 99.4%, 84%, and 73.2% using UC San Diego, PRED‐CT, and UI datasets, respectively. These results justify the effectiveness and robustness of the proposed model across diverse datasets, highlighting its potential for versatile applications in data analysis and prediction tasks. Our proposed hybrid spatiotemporal attention‐based model has been developed with 10‐fold cross‐validation (CV) for UC San Diego dataset and 10‐fold CV and leave‐one‐out cross‐validation (LOOCV) strategies for PRED‐CT and UI datasets. Our results indicate that the proposed PD detection system is accurate and robust. The developed prototype can be used for other neurodegenerative diseases such as Alzheimer's disease, Huntington's disease, and so forth.

Human Papillomavirus Perceptions, Vaccine Uptake, and Sexual Risk Factors in Students Attending a Large Public Midwestern University.

Background: It was to understand HPV vaccination patterns, uptake, perceptions, and sexual risk factors in students at a Midwest public university. Participants: Students were enrolled during the spring 2024 semester at the University of Iowa. Methods: A survey was developed and emailed to 28,095 students asking demographic, general and sexual health, and HPV-related questions. Results: The response rate was 4.9%, with 76% females and a median age of 22. The HPV vaccine uptake was 82%, with 88% recommending the vaccine. Parental preference was the main reason for being unvaccinated. The median age of sexual debut was 17 years, with a median of 2 sexual partners. Vaccination was associated with female, health science, sexually active, and COVID-19/influenza vaccinated students. Conclusions: HPV vaccine uptake at University of Iowa students is higher than the national and Iowa averages. Increased education regarding HPV vaccination is still needed, particularly in males, those not having sex, and those not receiving other vaccines.