Publications by authors named "Stephen Deppen"

Background: Radiomics has shown promise in improving malignancy risk stratification of indeterminate pulmonary nodules (IPNs) with many platforms available, but with no head-to-head comparisons. This study aimed to evaluate transportability of radiomic models across platforms by comparing performances of a commercial radiomic feature extractor (HealthMyne) with an open-source extractor (PyRadiomics) on diagnosis of lung cancer in IPNs.

Methods: A commercial radiomic feature extractor was used to segment IPNs from computed tomography (CT) scans, and a previously validated radiomic model based on commercial features was used as baseline (ComRad).

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Article Synopsis
  • Pulmonary nodules can be challenging to assess, leading to delays in diagnosing cancer and unnecessary tests for non-cancerous conditions.
  • This study evaluated the effectiveness of prediction models for assessing the likelihood of malignancy in nodules referred for biopsy, specifically using a cohort of 322 cases.
  • The results indicated that commonly used models (Brock, Mayo Clinic, and VA) had limited accuracy, while the Herder model showed better performance when PET-CT scans were included, suggesting a need for improved diagnostic tools in this area.
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Objective: Evaluate the association between provider-ordered viral testing and antibiotic treatment practices among children discharged from an ED or hospitalized with an acute respiratory infection (ARI).

Design: Active, prospective ARI surveillance study from November 2017 to February 2020.

Setting: Pediatric hospital and emergency department in Nashville, Tennessee.

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Background And Objectives: Factors prompting clinicians to request viral testing in children are unclear. We assessed patterns prompting clinicians to perform viral testing in children discharged from an emergency department (ED) or hospitalized with an acute respiratory infection (ARI).

Methods: Using active ARI surveillance data collected from November 2017 through February 2020, children aged between 30 days and 17 years with fever or respiratory symptoms who had a research respiratory specimen tested were included.

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Rationale: Skeletal muscle fat infiltration progresses with aging and is worsened among individuals with a history of cigarette smoking. Many negative impacts of smoking on muscles are likely reversible with smoking cessation.

Objectives: To determine if the progression of skeletal muscle fat infiltration with aging is altered by smoking cessation among lung cancer screening participants.

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Background: Assessing the clinical utility of biomarkers is a critical step before clinical implementation. The reclassification of patients across clinically relevant subgroups is considered one of the best methods to estimate clinical utility. However, there are important limitations with this methodology.

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Introduction: Small cell lung cancer (SCLC) is characterized by poor prognosis and challenging diagnosis. Screening in high-risk smokers results in a reduction in lung cancer mortality, however, screening efforts are primarily focused on non-small cell lung cancer (NSCLC). SCLC diagnosis and surveillance remain significant challenges.

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Background: Appropriate risk stratification of indeterminate pulmonary nodules (IPNs) is necessary to direct diagnostic evaluation. Currently available models were developed in populations with lower cancer prevalence than that seen in thoracic surgery and pulmonology clinics and usually do not allow for missing data. We updated and expanded the Thoracic Research Evaluation and Treatment (TREAT) model into a more generalized, robust approach for lung cancer prediction in patients referred for specialty evaluation.

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Lung cancer is the leading cause of cancer-related deaths. Early detection and diagnosis are critical, as survival decreases with advanced stages. Approximately 1.

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Background: Patients who are symptomatic from diaphragmatic dysfunction may benefit from diaphragmatic plication. We recently modified our plication approach from open thoracotomy to robotic transthoracic. We report our short-term outcomes.

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Objectives: To systematically review and evaluate diagnostic models used to predict viral acute respiratory infections (ARIs) in children.

Design: Systematic review.

Data Sources: PubMed and Embase were searched from 1 January 1975 to 3 February 2022.

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Article Synopsis
  • A study evaluated a deep learning model (LCP CNN) for assessing indeterminate pulmonary nodules (IPNs), finding it outperformed traditional clinical models but only used data from a single timepoint.
  • Researchers analyzed changes in LCP CNN scores over time to see if they differed between benign and malignant nodules, using a specific study design that involved multiple CT scans and blinded assessments.
  • Results showed that while benign nodules had stable LCP CNN scores, malignant nodules exhibited increasing scores over time, indicating that longitudinal analysis may enhance predictions of lung cancer risk.
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Although when used as a lung cancer screening tool low-dose computed tomography (LDCT) has demonstrated a significant reduction in lung cancer related mortality, it is not without pitfalls. The associated high false positive rate, inability to distinguish between benign and malignant nodules, cumulative radiation exposure, and resulting patient anxiety have all demonstrated the need for adjunctive testing in lung cancer screening. Current research focuses on developing liquid biomarkers to complement imaging as non-invasive lung cancer diagnostics.

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The literature remains scarce regarding the varying point estimates of risk factors for COVID-19 associated mortality and hospitalization. This meta-analysis investigates risk factors for mortality and hospitalization, estimates individual risk factor contribution, and determines drivers of published estimate variances. We conducted a systematic review and meta-analysis of COVID-19 related mortality and hospitalization risk factors using PRISMA guidelines.

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Objective: Indeterminate pulmonary nodules (IPNs) represent a significant diagnostic burden in health care. We aimed to compare a combination clinical prediction model (Mayo Clinic model), fungal (histoplasmosis serology), imaging (computed tomography [CT] radiomics), and cancer (high-sensitivity cytokeratin fraction 21; hsCYFRA 21-1) biomarker approach to a validated prediction model in diagnosing lung cancer.

Methods: A prospective specimen collection, retrospective blinded evaluation study was performed in 3 independent cohorts with 6- to 30-mm IPNs (n = 281).

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Background: Assessment and feedback is a common implementation strategy to improve healthcare provider fidelity to clinical guidelines. For immunization guidelines, fidelity is often measured with doses administered during eligible visits. Adding a patient refusal measure captures provider fidelity more completely (i.

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Background: Indeterminate pulmonary nodules (IPN) are a diagnostic challenge in regions where pulmonary fungal disease and smoking prevalence are high. We aimed to determine the impact of a combined fungal and imaging biomarker approach compared with a validated prediction model (Mayo) to rule out benign disease and diagnose lung cancer.

Methods: Adults ages 40 to 90 years with 6-30 mm IPNs were included from four sites.

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Observational studies found inverse associations of dietary carotenoids and vitamin A intakes with lung cancer risk. However, interventional trials among high-risk individuals showed that β-carotene supplements increased lung cancer risk. Most of the previous studies were conducted among European descendants or Asians.

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Article Synopsis
  • The study aims to improve lung cancer diagnosis in patients with indeterminate pulmonary nodules by using a deep learning network that integrates clinical data and CT images, potentially reducing unnecessary procedures and risk for patients.
  • Researchers employed a retrospective design and a two-path deep learning approach, validating their model using data from multiple sites and comparing it against established clinical and image-only prediction models.
  • Results showed that the new co-learning model outperformed traditional prediction methods in accuracy (AUC), achieving notably higher scores on multiple validation datasets, thus enhancing early cancer detection capabilities.
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Ionizing radiation is an established carcinogen, but its effects on non-malignant respiratory disease (NMRD) are less clear. Cohorts exposed to multiple risk factors including radiation and toxic dusts conflate these relationships, and there is a need for clarity in previous findings. This systematic review was conducted to survey the body of existing evidence for radiation effects on NMRD in global nuclear worker cohorts.

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Background: Non-invasive biomarkers are needed to improve management of indeterminate pulmonary nodules (IPNs) suspicious for lung cancer.

Methods: Protein biomarkers were quantified in serum samples from patients with 6-30 mm IPNs (n = 338). A previously derived and validated radiomic score based upon nodule shape, size, and texture was calculated from features derived from CT scans.

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Background: Diagnostic prediction models are useful guides when considering lesions suspicious for cancer, as they provide a quantitative estimate of the probability that a lesion is malignant. However, the decision to intervene ultimately rests on patient and physician preferences. The appropriate intervention in many clinical situations is typically defined by clinically relevant, actionable subgroups based upon the probability of malignancy.

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The Early Detection Research Network's (EDRN) purpose is to discover, develop and validate biomarkers and imaging methods to detect early-stage cancers or at-risk individuals. The EDRN is composed of sites that fall into four categories: Biomarker Developmental Laboratories (BDL), Biomarker Reference Laboratories (BRL), Clinical Validation Centers (CVC) and Data Management and Coordinating Centers. Each component has a crucial role to play within the mission of the EDRN.

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Many clinical natural language processing methods rely on non-contextual word embedding (NCWE) or contextual word embedding (CWE) models. Yet, few, if any, intrinsic evaluation benchmarks exist comparing embedding representations against clinician judgment. We developed intrinsic evaluation tasks for embedding models using a corpus of radiology reports: term pair similarity for NCWEs and cloze task accuracy for CWEs.

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