Raphiel J. Murden

Legal epidemiology is a growing field wherein researchers examine the effects of health policies on health outcomes. Policy surveillance is a key part of the legal epidemiology process and leads to the creation of a legal dataset for econometric analyses. Policy surveillance includes conceptualizing the research scope, collecting legal data, and coding data to answer legal questions. Historically, policy surveillance has been slow and time-consuming, limiting timely information about the effects of health policies on health outcomes. Researchers are exploring the role of artificial intelligence using large language models (LLMs) to increase the efficiency and quality of the policy surveillance process. In this commentary, we describe potential uses of LLMs by researchers conducting policy surveillance as well as potential challenges that will need to be addressed before LLMs are widely used in the process. We also suggest areas for future research while emphasizing the need for development of guidelines for LLM use in policy surveillance.

Aims: Appendiceal goblet cell adenocarcinoma (GCA) is an uncommon malignancy that has been described under various names and grading schemes. The 5th Edition of the World Health Organization (WHO) Classification of Digestive System Tumours provides a three‐tiered system for grading these neoplasms, but the reproducibility of this classification scheme has not been studied. Methods and Results: We scanned 58 H&E‐stained slides from 20 GCA and circulated the whole‐slide images among seven pathologists with interest in appendiceal pathology. They evaluated each slide for the presence of 15 histological patterns defined by the WHO as criteria for low‐grade ( n = 5) and high‐grade ( n = 10) GCA. Cases were also evaluated for the presence of extracellular mucin. Participants also reported the percentage of high‐grade features in each whole slide image and each case. Interobserver variability was assessed statistically. All seven observers agreed on the WHO grade for four of the 20 cases (20%; one grade 1, three grade 3). Using Fleiss's kappa statistic, overall agreement for cases was fair at 0.29 (95% confidence interval [CI]: 0.14–0.44), and pairwise agreement between observers ranged from 0.00 to 0.82 (median = 0.13). Gwet's agreement coefficient ranged from 0.10 to 0.87 (median = 0.28), while overall agreement was 0.36 (95% CI: 0.17–0.54). There was significant variability with respect to assessing the presence of individual features. The best agreement was seen for extracellular mucin (neutral feature, κ = 0.43) and tumour sheets (high‐grade feature, κ = 0.41), whereas the worst agreement was seen for mild architectural disarray/tubular fusion (low‐grade feature, κ = 0.05) and necrosis (high‐grade feature, κ = 0.07). Conclusions: We conclude that interobserver agreement for grading GCA using the three‐tiered WHO 5th Edition classification system is fair at best. A validated two‐tiered system (i.e. low‐ versus high‐grade) may be more reproducible.

Collecting multiple types of data on the same set of subjects is common in modern scientific applications including genomics, metabolomics, and neuroimaging. Joint and Individual Variation Explained (JIVE) seeks a low-rank approximation of the joint variation between two or more sets of features captured on common subjects and isolates this variation from that unique to each set of features. We develop an expectation-maximization (EM) algorithm to estimate a probabilistic model for the JIVE framework. The model extends probabilistic PCA to multiple datasets. Our maximum likelihood approach simultaneously estimates joint and individual components, which can lead to greater accuracy compared to other methods. We apply ProJIVE to measures of brain morphometry and cognition in Alzheimer’s disease. ProJIVE learns biologically meaningful sources of variation, and the joint morphometry and cognition subject scores are strongly related to more expensive existing biomarkers. Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Code to reproduce the analysis is available at https://github.com/thebrisklab/ProJIVE.

Objective: African American women experience disproportionate cardiovascular disease risk, and altered central hemodynamics signal early vascular aging. For African American mothers, concern about their children’s exposure to racism represents a salient psychosocial stressor, but its vascular consequences are unclear. We examined whether greater racism‑related Concern for Children (CFC) was associated with adverse longitudinal changes in central hemodynamics. Methods: African American mothers aged 30-46 years ( n =236) underwent assessments of central systolic blood pressure (cSBP), augmentation index (AIx), pulse pressure amplification (PPA), and pulse wave velocity (PWV; n =205) at baseline and 4±1 years later. CFC was measured continuously (range 0-24) and categorically (high vs. low). Multivariable linear regression models examined associations between CFC and changes in central hemodynamics, adjusting for baseline values and sociodemographic, clinical, and psychosocial covariates. Logistic regression evaluated CFC and odds of newly developed high‑risk PPA (PPAP =0.002). At follow‑up, women with high CFC had AIx values 3.9 percentage points higher than those with low CFC ( P =0.005). CFC was also associated with declining PPA (b=‑0.003, 95% CI [‑0.005, ‑0.001]; P =0.024) and greater odds of newly developed high‑risk PPA (OR=1.08, 95% CI [1.01, 1.15]; P =0.033). No associations were observed for cSBP or PWV. Conclusions: Greater racism‑related concern for children is associated with signs of early vascular aging in African American mothers, highlighting the cardiovascular consequences of racism‑related maternal stress.

Background: Young Black sexual minority men are disproportionately affected by HIV, especially in the Southern United States. To address this, we developed Brothers Building Brothers by Breaking Barriers (B6) intervention with a goal of enhancing social capital and engagement in care among young Black sexual minority men living with HIV. However, we encountered challenges to feasibility in recruiting and engaging for an in-person intervention. Objective: The objectives of this study are to iteratively adapt the original B6 intervention for telehealth delivery (Phase 1), and pilot test the intervention through a waitlist-control trial to evaluate its feasibility, acceptability, and safety (Phase 2). Methods: In Phase 1, we used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework to structure the iterative adaptation process of B6, working with a diverse study team and a Youth Advisory Board (YAB). After completing the preliminary adaptation process, we conducted initial Telehealth Brothers Building Brothers by Breaking Barriers (Tele-B6) pilot testing with a community partner organization. The result was a 5-week group-level intervention, delivered entirely remotely, consisting of a series of adapted activities to address bonding and bridging social capital, affirm intersectional identities, and engage in resilience-building processes. Following feedback integration from pilot-testing, we conducted Phase 2 with 60 young Black sexual minority men living with HIV recruited over the course of one year and who were randomized at the group level to either the immediate intervention or delayed (waitlist control) intervention group. Various data sources will be used to measure feasibility, acceptability, and safety, including surveys, postsession evaluation data, in-depth qualitative interviews, and review of medical records for HIV clinical outcomes. Results: Phase 1, the adaptation process of B6, began in fall 2022 and was completed in spring 2023. Phase 2, the implementation of the waitlist control trial, began in spring 2023 and concluded in summer 2024. Final follow-up assessments were completed in fall 2024 and the results of the mixed methods evaluation are expected in winter 2025. Conclusions: The adaptation process and telehealth delivery of B6 will add to the knowledge of strengths-based interventions designed to improve care engagement among young Black sexual minority men living with HIV. Trial Registration: ClinicalTrials.gov NCT05829759,https://clinicaltrials.gov/study/NCT05829759 International Registered Report Identifier (IRRID): DERR1-10.2196/69961

Objective: Anti-black police violence and harassment have been identified as public health issues. However, studies have primarily focused on direct and/or vicarious police encounters. A dearth of studies has also examined vigilance related to future police encounters, and to our knowledge, no studies have examined all 3 kinds of police-related stress among African American women. Methods: We employed a latent class analysis (LCA) approach to identify classes of African American women ( N = 422), aged 30 to 46, based on the patterning of various forms of self-reported police-related stress: direct, vicarious, police-related vigilance for self, and police-related vigilance for children. We then examined associations between latent class membership and carotid intima media thickness (IMT), a marker of cardiovascular risk. Results: We identified 3 latent classes of police-related stress: (1) high child vigilance-high personal exposure, (2) no child vigilance-high personal exposure, and (3) moderate child vigilance-low self vigilance-low personal exposure class. Findings from the fully adjusted model reveal that the no child vigilance-high personal exposure class had lower common carotid artery (CCA) IMT than the high child vigilance-high personal exposure and moderate child vigilance-low self vigilance-low personal exposure classes. Conclusions: Vigilance for children’s future police encounters may be associated with increased cardiovascular risk in African American women. Agency, system, and policy-level solutions may be needed to reduce anti-black police violence and improve the cardiovascular health of this high-risk population.

Objective: Studies of body size and blood pressure (BP) in African American women typically focus on obesity overall or collapse obesity classes II and III into a single subgroup, ignoring potential heterogeneity in associations across categories. Moreover, ambulatory BP outcomes are primarily analyzed as mean daytime and/or nighttime BP, without examination of circadian changes during the day‐to‐night transition or the full 24‐h cycle.Methods: Functional data analysis methods were used to examine whether obesity categories modified ambulatory monitoring‐assessed BP circadian rhythm in a cohort of 407 African American women.Results: Age‐adjusted systolic BP (SBP) was 4 mm Hg (95% CI: 0.4–8.4) higher among women with class I or II obesity than those with normal weight or overweight from 12:30 p.m. through 8:00 a.m. Age‐adjusted differences in SBP among women with class III obesity versus those with normal weight or overweight were 6 mm Hg (95% CI: 0.7–10.8) during daytime hours and increased to 11 mm Hg (95% CI: 5.8–16.0) overnight. Compared with all other BMI categories, SBP of women with class III obesity declined more slowly from day to night.Conclusions: Circadian BP among African American women was distinct among those with class III obesity compared with those with other body weight categories, suggesting that intervention efforts in African American women should target this group.

Background: Emerging evidence suggests that the Superwoman Schema (SWS)—the sociocultural representation of Black women as naturally strong, independent, and nurturing—may play an important role in Black women’s cardiovascular health; but findings have been relatively mixed. One interesting possibility is that environmental mastery, a sense of control over one’s environment, may mitigate negative aspects of SWS. Purpose: We investigated whether mastery moderated the association between SWS and pulse wave velocity (PWV), the gold standard measure of arterial stiffness linked to cardiovascular morbidity and mortality. Methods: Participants were N = 368 early middle-aged (30-45 years old) Black women from the southeastern USA who completed the 35-item Giscombé Superwoman Schema Questionnaire and Ryff’s 14-item environmental mastery scale. Carotid-femoral PWV was assessed using the SphygmoCor device. Linear regression models examined the main and interactive associations of SWS and mastery on PWV, adjusting for age, education, income, body mass index, smoking status, blood pressure, and antihypertensive medication use. Results: Analyses revealed a significant overall SWS endorsement by mastery interaction [β = −.11, P = .02], such that SWS was positively associated with higher PWV only when mastery was low. Three SWS dimensions drove this association: SWS strength, SWS suppress emotions, and SWS resistance to vulnerability (all P-values < .05) showing similar patterns to the overall SWS interaction with mastery. Conclusions: In Black women, high endorsement of SWS is associated with greater arterial stiffness when environmental mastery is low. Thus, SWS may be more physiologically taxing when one senses less control over their environment.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Young Black sexual minority men are disproportionately affected by HIV, especially in the Southern United States. To address this, we developed Brothers Building Brothers by Breaking Barriers (B6) intervention with a goal of enhancing social capital and engagement in care among young Black sexual minority men living with HIV. However, we encountered challenges to feasibility in recruiting and engaging for an in-person intervention. Objective: The objectives of this study are to iteratively adapt the original B6 intervention for telehealth delivery (Phase 1), and pilot test the intervention through a waitlist-control trial to evaluate its feasibility, acceptability, and safety (Phase 2). Methods: In Phase 1, we used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework to structure the iterative adaptation process of B6, working with a diverse study team and a Youth Advisory Board (YAB). After completing the preliminary adaptation process, we conducted initial Telehealth Brothers Building Brothers by Breaking Barriers (Tele-B6) pilot testing with a community partner organization. The result was a 5-week group-level intervention, delivered entirely remotely, consisting of a series of adapted activities to address bonding and bridging social capital, affirm intersectional identities, and engage in resilience-building processes. Following feedback integration from pilot-testing, we conducted Phase 2 with 60 young Black sexual minority men living with HIV recruited over the course of one year and who were randomized at the group level to either the immediate intervention or delayed (waitlist control) intervention group. Various data sources will be used to measure feasibility, acceptability, and safety, including surveys, postsession evaluation data, in-depth qualitative interviews, and review of medical records for HIV clinical outcomes. Results: Phase 1, the adaptation process of B6, began in fall 2022 and was completed in spring 2023. Phase 2, the implementation of the waitlist control trial, began in spring 2023 and concluded in summer 2024. Final follow-up assessments were completed in fall 2024 and the results of the mixed methods evaluation are expected in winter 2025. Conclusions: The adaptation process and telehealth delivery of B6 will add to the knowledge of strengths-based interventions designed to improve care engagement among young Black sexual minority men living with HIV. Trial Registration: ClinicalTrials.gov NCT05829759,https://clinicaltrials.gov/study/NCT05829759