Jacob J. Oleson

Objective: To identify the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of intraoperative surgeon‐perceived margin status via gross examination compared to histologic evaluation for marginal and wide cutaneous mass excisions. Study design: Multicenter prospective cohort study. Animal population: A total of 84 dogs and six cats with 102 cutaneous masses. Methods: Four surgeons completed a survey assessing margin completeness after mass removal prior to histologic results. Results: Surgeon ability to identify incomplete margins had a sensitivity of 56.3%, specificity of 87.2%, PPV of 45%, NPV of 91.5%, and accuracy of 82.4%. Surgeon margin assessment was correct in 58.5% of marginally excised and 98.4% of widely excised masses: odds ratio (OR) 0.024 (confidence interval [CI]: 0.003, 0.19). Margin assessment based upon cytologic malignancy status was correct in nine of 14 (64.3%) benign lesions and 75 of 88 (85.2%) malignant lesions: OR 0.31 (CI: 0.09, 1.1). Conclusion: Surgeons did not have improved accuracy in margin assessment for cytologically benign masses compared with malignant masses. Surgeon margin assessment correctness may be influenced by surgical dose. Additionally, when surgeons suspected a complete margin, there was a high probability that the histologic margin was complete. Limitations included the diversity of cases enrolled, few participating surgeons, potential non‐blinded assessment bias, and lack of clinical follow up. Clinical significance: Veterinary surgeons can provide owners an assessment of margin completeness with a degree of confidence for wide mass excision. Caution should persist in assessment of marginally excised tumors. This information allows owners to contemplate further treatment pending histopathology results.

Iron is essential for neurophysiological health. Prior work has shown that subcortical tissue iron levels are the highest among all brain regions but also change over the lifespan. Recent functional MRI (fMRI) studies have provided evidence that an fMRI-derived iron-sensitive signal may index relative iron concentration in subcortical regions. In this context, we aimed to characterize the lifespan trajectory of this fMRI-derived iron-sensitive signal (relative iron quantification) in 10 subcortical regions and 14 thalamic nuclei from 881 healthy participants aged 12 to 88 years, using resting-state fMRI. Regressions were run with age as a predictor, separately for males (N = 429) and females (N = 452). The main results show non-linear effects of age, with an overall increase in iron levels across most subcortical regions within each sex. Six of the 14 thalamic nuclei in male participants had similar slopes of their lifespan iron levels, showing some homogeneity. The thalamic nuclei of female participants showed less agreement in slopes. This study provides new insight into the typical trajectory of iron levels across all major subcortical regions throughout the lifespan.

Background: Early and adequate prenatal care is associated with improved maternal and infant health outcomes. In Iowa, a switch to Managed Care Organizations (MCOs) for Medicaid recipients in 2016 was intended to increase care provision, particularly for rural Iowans. This study examines whether prenatal care initiation in the first trimester and adequacy of prenatal care improved following the MCO transition, and whether this varied by rurality. Method: Birth certificate data for 236,034 births in Iowa from 2013 to 2019 were provided by the Iowa Department of Health & Human Services. This sample included 90,440 Medicaid paid births; 37,898 occurred before MCO implementation (2013–2015), and 39,499 occurred after (2017–2019). Generalized additive models were used to examine relationships between early and adequate care and sociodemographic attributes in the pre‐MCO and post‐MCO phases. Potential variation in MCO impacts by rurality of birth parent residence was also assessed. Results: Among Medicaid paid births, early initiation of prenatal care was stable across the pre‐MCO (77.26%) and post‐MCO (77.23%) period, as was adequate prenatal care use (80.70% pre‐MCO versus 79.22% post‐MCO transition), and both outcomes varied according to sociodemographics. The post‐MCO transition period was not associated with a change in odds of early care initiation but was associated with 5.8% lower odds of adequate care use (OR = 0.942, CI 0.902, 0.984). Among rural parents in the post‐MCO transition period, there was a 11.5% (OR = exp(0.020+ 0.089) = 1.115) higher odds of initiating care early compared to the pre‐MCO transition period. Rural parents did not experience any significant differences in adequate care use after MCO implementation. Conclusion: While the period following the MCO transition improved prenatal care initiation among rural parents, additional geographic and sociodemographic barriers must be identified and addressed to ensure the maintenance of prenatal care throughout pregnancy.

PURPOSE: Cancer registries are often asked to present cancer data for small geographic areas to inform and facilitate targeted interventions and prevention programs. However, it is challenging to compute and visualize reliable cancer estimates for areas with small case counts and populations to support cancer control planning. METHODS: Leveraging a user-centered design process, we developed a visual analytics platform and interactive graphics to display modeled cancer risk estimates for small areas. Development of our visual analytics platform was informed by cancer registry and public health professionals through focus groups and surveys. The reliable cancer risk estimates for small areas that we displayed on this platform were created using a Bayesian hierarchical model that borrows strength from neighboring areas and over time to produce cancer estimates for small areas. RESULTS: The Cancer Analytics and Maps for Small Areas tool (CAMSA) provided age-adjusted cancer incidence and mortality rates and risk probabilities for eight cancers at the county and ZIP-code tabulation area levels. It allowed the user to identify areas of high cancer incidence, including among subgroups defined by sex and race/ethnicity. Potential end users were enthusiastic about the opportunity to implement CAMSA within their practice, emphasizing the tool's potential for increased collaborative opportunities at local and state levels. Suggestions for improvement included adding map overlays such as additional cancer risk variables and incorporating functionalities such as exportable data tables. CONCLUSION: CAMSA presented cancer rate and risk estimates for small geographic areas where they may have previously been suppressed. Through our user-centered design process, we developed statistical models and data visualizations to support the needs of an array of potential end users.

Nearly all questionnaires of externalizing problems use vague quantifiers of relative frequency (e.g., rarely/sometimes/often) or true/false statements. Vague quantifiers have many problems, including imprecision and low interpretability. An alternative is numeric quantifiers that quantify, in absolute frequency, how many times the person engaged in the behavior during a given time frame. This study evaluates whether absolute frequency provides utility for assessing the externalizing spectrum. Participants included adults recruited online and college students, for a combined sample of 1,237 adults (290 males; 947 females) spanning 18-92 years of age. A subset of items was adapted from the Externalizing Spectrum Inventory to assess absolute frequency, supplemented with additional items to ensure broad coverage. Using a 30-day reference period, participants indicated how many times they engaged in each behavior per day, per week, in the past month, or in the prior year. Externalizing problems showed age-related decreases from early to later adulthood. On average, men showed greater externalizing problems than women in early and older adulthood; women showed greater externalizing problems than men in middle adulthood. Latent scores derived from absolute frequency items demonstrated convergent validity with a widely used measure of externalizing problems (Adult Self-Report), discriminant validity with respect to internalizing problems, and criterion and incremental validity in relation to functional impairment and inhibitory control. Count data led to greater precision-less uncertainty in the estimate of each person's level of externalizing problems-than dichotomized versions of the items. Findings suggest there is key utility in assessing absolute frequency of externalizing behavior. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose: This study aimed (1) to determine the biological basis of the interphase gap (IPG) effect and (2) to identify the most informative parameters, analytical methods, and quantitative scales for evaluating the IPG effect in human cochlear implant (CI) users. Methods: The IPG effect was quantified using multiple parameters, analytical methods, and quantitative scales (three combinations using linear or logarithmic scales for the input and output variables) across three pediatric CI groups with differing cochlear nerve (CN) anatomy: children with cochlear nerve deficiency (CND), GJB2 mutations, and idiopathic sensorineural hearing loss (SNHL). All participants in the GJB2 and idiopathic SNHL groups had normal-sized CNs (NSCNs) in the test ear. Neural synchrony, a property depending on neural health, was assessed using phase locking value (PLV) and compared between children with CND and those with GJB2 mutations. Results: The PLV did not differ significantly between the CND and GJB2 groups, nor did it correlate with the IPG effect in GJB2 cases, regardless of parameter, analytical method, or quantitative scale. In contrast, consistent group differences in IPG effects on stimulation level offset and maximum slope of the eCAP input/output function were observed across all analytical methods and quantitative scales. The sensitivity of other eCAP measures—threshold, maximum amplitude, and overall linear slope—to group differences varied by quantitative scale. Conclusions: The IPG effect primarily reflects the number of active CN fibers rather than their health. Stimulation level offset and the IPG effect on maximum slope are robust indicators of CN fiber counts in CI users and are unaffected by the choice of quantitative scale.

Purpose: This study aims to address the critical gap in research on real-time language processing in adults with developmental language disorder (DLD). We examine whether adults with DLD continue to exhibit differences in the dynamics of spoken word recognition observed in childhood or whether these differences resolve by adulthood. Additionally, drawing on data from the Iowa Longitudinal Study, we investigate how individual differences in adult word recognition are shaped by early childhood language abilities. Method: Adults aged 34–36 years ( n = 71; 28 with a childhood diagnosis of DLD) were recruited from a cohort of individuals who participated in the Iowa Longitudinal Study. The dynamics of spoken word recognition were assessed using eye tracking in the visual world paradigm in which participants heard a word and selected the correct visual referent from a display of four images: the target (“money”), phonological competitors (cohort [e.g., “mother”] or rhyme [e.g., “honey”]), and unrelated items (“whistle” and “blanket”). Results: We analyzed eye fixations to the target to assess the degree and speed of recognition and fixations to competitors to evaluate the timing and strength of lexical competition across groups. Adults with DLD activated targets and competitors similarly to adults with typical language, no longer exhibiting deficits found in childhood. However, across groups, both regression and principal component analyses revealed that individual differences in language scores in kindergarten are strongly linked to the dynamics of word recognition 30 years later. Conclusions: Results suggest that, by adulthood, the dynamics underlying spoken word recognition for familiar words are largely similar in adults with and without DLD. However, individual differences in spoken word recognition in adulthood are strongly predicted by language ability in kindergarten. Findings emphasize the role of early language skills in laying the foundation for basic language processes in adulthood and underscore the importance of viewing language ability as a continuous spectrum rather than a categorical construct. Supplemental Material: https://doi.org/10.23641/asha.31158757

Purpose: The aim of this study was to evaluate group- and individual-level impact of ECoLoGiC (Expanding Communication and Language Opportunities Generated in Conversation) Treatment (ECoLoGiC-Tx), an aphasia intervention aimed at improving conversational language. In addition, treatment fidelity for the speech-language pathologists (SLPs) who delivered treatment was evaluated, providing feasibility data to optimize successful future field implementation. Method: Ten people with moderate or severe aphasia completed 10 weeks of ECoLoGiC-Tx delivered twice weekly for 1 hr. Testing occurred at pretreatment, posttreatment, and at 6 weeks maintenance. Conversation/monologue samples were collected three times per testing phase. Group results were analyzed using linear mixed models. Individual data were analyzed using effect size and minimal detectable change criteria. Treatment fidelity was analyzed using an established 23-point checklist. Results: Robust results indicate generalization across measure types at group and individual levels. Participants improved their ability to convey meaning in conversation, the primary focus of ECoLoGiC-Tx. They demonstrated an average gain of 11.31 points on the Western Aphasia Battery–Revised (range: −1 to 21.5), and 7/10 participants shifted to a less impaired category of severity (e.g., from severe to moderate aphasia). Group-level change did not occur for reading, sentence construction in a picture task or in monologue, or Grammaticality in conversation/monologue. SLP fidelity was 97.3%. Conclusions: Pilot study findings were replicated, with robust group and individual results. Exceptional improvements occurred for 9/10 participants. Results demonstrate generalization of skills to conversation and reduced aphasia severity for most participants. Deliverability of ECoLoGiC-Tx was evidenced by very high treatment fidelity by practicing SLPs, suggesting good potential for successful field implementation. Supplemental Material: https://doi.org/10.23641/asha.30856571

Background: Effective antibiotic stewardship programing in clinical settings necessitates a good understanding of local prevalences of antimicrobial resistance and important patient and community risk factors. However, most studies are limited in sample size and geographic coverage. Methods: This study utilized phenotypic resistance data of Escherichia coli from the Veteran’s Health Administration of the United States (U.S.), incorporating 126,777 unique cultures from veteran outpatients from seven Midwest states from 2010 to 2023, to examine the spatial pattern and important individual- and county-level risk factors for resistance to four important classes of antibiotics. We utilized Bayesian conditional autoregressive zero-inflated Poisson regression models to generate smoothed rates of resistance in each county and multilevel logistic regression models to detect risk factors for resistance. Results: High overall rates of resistance were seen for fluoroquinolone (29%) and TMP-SMX (22%). Geographic variation was seen among and between antibiotic classes. Certain urban regions in the southern parts of Illinois, Indiana, and Ohio had higher local resistance rates for fluoroquinolone and TMP-SMX. Being male, having diabetes, and previous exposure to antibiotics are significant risk factors for all classes of antibiotics while the significance of other risk factors varied across classes. Conclusion: Diverse geographic patterns of resistance level may reflect differences in local prescribing practices, while the differential correlations with risk factors likely reflect their clinical indications and prescribing patterns in clinical settings. The local resistance rates and risk factors for different classes of antibiotics should provide important guidance in practicing empirical prescribing and antibiotic stewardship in clinical settings.