Publications by authors named "Joanna Nelson"

Cytomegalovirus (CMV) reactivation is a rare complication in patients treated with immune checkpoint inhibitors (ICIs), typically occurring after immunosuppressive therapy for immune-related adverse events (irAEs). Here, we report a unique case of severe CMV gastritis in a patient receiving cemiplimab, an anti-PD-1 antibody, and talimogene laherparepvec (T-VEC), an oncolytic virus, without prior irAEs or immunosuppressive treatment. A 63-year-old man with advanced cutaneous squamous cell carcinoma received cemiplimab for one year and a single T-VEC injection for recurrent disease.

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Article Synopsis
  • Large language models (LLMs) can perform various language tasks without specific training data, but their inaccurate and potentially harmful outputs limit their use in clinical settings.
  • A study evaluated Almanac, an LLM framework designed for medical guidance, by comparing it with standard LLMs like ChatGPT-4, based on responses to 314 clinical questions from a panel of healthcare experts.
  • Results indicated that Almanac significantly outperformed standard LLMs in factuality, completeness, user satisfaction, and safety, highlighting the need for thorough testing of these models before clinical application.
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Purpose Of Review: Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice.

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Article Synopsis
  • Large-language models have shown strong performance in tasks like summarization and dialogue generation, but their use in clinical medicine is hindered by inaccuracies and harmful outputs.
  • The study introduces Almanac, a model enhanced with retrieval features for providing medical guidelines and treatment recommendations, which was tested using clinical scenarios evaluated by physicians.
  • Findings indicate that Almanac improved factuality by an average of 18% and also enhanced completeness and safety, highlighting the model's potential in clinical decision-making when properly tested and implemented.
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Background: Bronchiolitis obliterans syndrome (BOS)-chronic graft-versus-host disease (cGVHD) affecting the lungs-is an uncommon complication of allogeneic hematopoietic cell transplant (HCT). The epidemiology and complications of lower respiratory tract infections (LRTIs) and community-acquired respiratory viruses (CARVs) in these patients are poorly understood.

Objectives: We aim to characterize the epidemiology of LRTIs in patients with BOS complicating HCT.

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Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR.

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Background.  Endocarditis is a rare manifestation of infection with Coccidioides. This is the first reported case of donor-derived Coccidioides endocarditis obtained from a heart transplant.

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Scholars have made great advances in modeling and mapping ecosystem services, and in assigning economic values to these services. This modeling and valuation scholarship is often disconnected from evidence about how actual conservation programs have affected ecosystem services, however. Without a stronger evidence base, decision makers find it difficult to use the insights from modeling and valuation to design effective policies and programs.

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Febrile travelers from countries with unique endemic pathogens pose a significant diagnostic challenge. In this report, we describe the case of a Tongan man presenting with fever, rash, and altered mental status. The diagnosis of Chikungunya encephalitis was made using a laboratory-developed real-time RT-PCR and serologic testing.

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Coastal salt marshes are among Earth's most productive ecosystems and provide a number of ecosystem services, including interception of watershed-derived nitrogen (N) before it reaches nearshore oceans. Nitrogen pollution and climate change are two dominant drivers of global-change impacts on ecosystems, yet their interacting effects at the land-sea interface are poorly understood. We addressed how sea-level rise and anthropogenic N additions affect the salt marsh ecosystem process of nitrogen uptake using a field-based, manipulative experiment.

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Human activities are altering many factors that determine the fundamental properties of ecological and social systems. Is sustainability a realistic goal in a world in which many key process controls are directionally changing? To address this issue, we integrate several disparate sources of theory to address sustainability in directionally changing social-ecological systems, apply this framework to climate-warming impacts in Interior Alaska, and describe a suite of policy strategies that emerge from these analyses. Climate warming in Interior Alaska has profoundly affected factors that influence landscape processes (climate regulation and disturbance spread) and natural hazards, but has only indirectly influenced ecosystem goods such as food, water, and wood that receive most management attention.

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