The epidemiology and clinical characteristics of familial myelodysplastic syndromes/acute myeloid leukemia (MDS/AML) remain poorly understood, particularly among Native Hawaiians and other Pacific Islanders (NHOPI). To investigate the real-world evidence in this area, we conducted a retrospective study at the Queen's Medical Center, Hawaii's largest tertiary referral hospital. This study is based solely on self-reported family histories and interviews, without germline genetic validation. Among 1686 MDS/AML patients who presented between January 2012 and July 2023, 12 (0.71%) had familial MDS/AML and 25 (1.48%) had a family history of unspecified leukemia. While no NHOPI were identified among patients with familial MDS/AML, 20% of patients with a family history of unspecified leukemia were NHOPI. The median age at diagnosis of familial MDS/AML was 70 years, and 50% of familial MDS patients had MDS with low blasts based on the WHO 2022 classification. The median overall survival (OS) time and 5-year OS rate for familial MDS were 12.7 years and 75.0%, respectively. In contrast, familial AML had a median OS time of 0.85 years and a 3-year OS rate of 33.3%. Our study provides new insights into familial MDS/AML in Hawaii's multiethnic population.
Artificial intelligence is a useful tool for examining suicidality on social media, where people share their thoughts. However, existing research has primarily focused on text analysis to predict risk in single posts and raised privacy concerns. This study aimed to use text, images, and user features on Instagram to predict the risk of each user in Hawaii with user permission. One hundred forty-two participants completed online questionnaires about their current suicidal ideation. With their consent, their Instagram data were collected to train Artificial intelligence model to predict suicidal ideation of each user. Thirty-three (23.2%) participants reported having current suicidal ideation. The best model predicts suicidal ideation with 52% sensitivity, 92% specificity, 65% positive predictive value, and 82% accuracy. The significant predictors were negative description, lower hue and more red in an image, fewer nature and sky images, more art, fashion, a close-up of a body part, and spoof content in an image. These findings highlight the potential of suicide prediction on social media, which help mental health providers plan patient online interventions and appointments. Additionally, the influence of Hawaii's unique social-cultural context on significant predictors, helping gatekeepers to recognize signs of suicide on the social media of people in Hawaii. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Hawaii implemented a statewide Community Palliative Care benefit in 2025 under its Section 1115 Medicaid Demonstration waiver to expand access to interdisciplinary palliative care for Medicaid beneficiaries with serious illnesses. This policy analysis synthesizes federal and state policy documents, implementation guidance, and relevant literature to describe the development, operational design, and implementation strategy of the benefit. The benefit establishes standardized eligibility criteria, interdisciplinary staffing expectations, unified documentation standards, and a blended reimbursement model. Development incorporated extensive stakeholder engagement, including clinicians, managed care organizations, hospice programs, and community organizations. Hawaii's model provides a structured statewide framework for Medicaid-covered community-based palliative care and offers lessons for other states seeking to expand access to serious illness care.
The Joint Critical Care Advanced Support Team maintains Hawaii's limited critical care capacity during Indo-Pacific Large-Scale Combat Operations, ensuring a net-neutral patient flow. This military-civilian effort ensures that critical care patients receive timely life-saving care while stabilized patients are moved to the Continental United States, preserving Hawaii's healthcare balance.
The tropical nut borer, Hypothenemus obscurus (F.) (Coleoptera: Curculionidae: Scolytinae), is a significant economic pest in Hawaii's macadamia orchards, contributing to substantial pre- and postharvest losses. Existing management strategies relying on cultural controls and generalist predators have been proven inefficient. This study developed and evaluated a trap-based monitoring system integrating both olfactory and visual cues to improve pest monitoring and management for H. obscurus. Field trials conducted over 2 yr assessed various alcohol-based lure formulations and trap color preferences under commercial orchard conditions. Results demonstrated that lures containing higher proportions of methanol, particularly at a 100% concentration and 3:1 methanol-to-ethanol ratio, captured significantly more H. obscurus than ethanol-only lures. Trap placement at 1.5 m in the lower canopy yielded higher captures compared to ground-deployed traps. Color trials revealed that transparent bottle traps achieved the highest captures, followed by brown and red, while yellow and white traps were the least effective. In summary, methanol-baited, transparent bottle traps deployed in the lower canopy of trees proved to be most effective in capturing H. obscurus, highlighting the importance of integrating semiochemical and visual stimuli as well as trap placement to enhance trap effectiveness. The implications of our findings for the enhancement of early detection, timely interventions, and improvement of integrated pest management strategies for H. obscurus are discussed.
The floriculture and nursery industry is a key contributor to Hawaii's economy, with ornamental crop exports, particularly cut flowers, accounting for a significant portion of sales. However, pest-related shipment rejections have increasingly threatened market access. As a first step to develop an effective systems approach for maintaining market access, we analyzed California interception records from 2012 to 2016, which revealed 582 cut flower shipment interceptions from 92 Hawaiian growers and shippers, with rejections primarily due to ants, aphids, mealybugs, and scale insects for non-orchid cut flowers (eg ginger and heliconia) and thrips for cut orchid flowers (eg Dendrobium). For targeted trials of ginger and heliconia, the effect of sequential pre-harvest (systemic insecticide spraying and ant baiting) and postharvest treatments (washing, hot water treatment, and second washing) were evaluated under commercial conditions. While individual treatments alone did not achieve complete disinfestation of ginger and heliconia, combining them as a systems approach led to zero detectable infestation across 8 harvests during the second year of the study, indicating this may be a feasible phytosanitary strategy for Hawaii-grown cut flowers. In contrast, for Dendrobium orchids with limited postharvest treatment options, pre-harvest insecticide programs were ineffective for managing thrips, with 30% of Dendrobium flowers and 70% of the flower sprays remaining infested post-insecticide treatment, highlighting the need for improved thrips management and the potential for integrating with postharvest fumigation. Overall, our results demonstrate the potential of systems approach in reducing pest interceptions and supporting continued access of Hawaii-grown cut flowers to US mainland and international markets.
Lepidoptera is the most herbivorous of all the insect orders, with predatory caterpillars globally comprising less than 0.13% of the nearly 200,000 moth and butterfly species. Here, we report a species in which caterpillars are carnivorous inhabitants of spider's webs, feeding on the arthropods that they find there. This Hawaiian lineage also boasts an unprecedented and macabre practice of decorating its portable larval home with the body parts of the spider prey it harvests from the web where it resides. Phylogenomic data suggest that the origin of this unique spider cohabitant is at least six million years old, more than one million years older than Hawaii's current high islands. After decades of searching, only one species has been discovered, and it is restricted to 15 square kilometers of a single mountain range on the island of O'ahu, meaning that other members of the lineage have disappeared from older islands. Conservation action to save this globally unique lineage is imperative and overdue.
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare phenomenon. Review of the literature revealed 2425 DRESS syndrome case reports and only 175 case reports secondary to allopurinol, with this being the first published report of DRESS Syndrome in the state of Hawai'i. This case report describes a Han-Chinese patient diagnosed with DRESS syndrome secondary to allopurinol use, which has been reported to be a high-risk group for allopurinol-related drug reactions. Given Hawaii's unique patient population, compromised of a large Chinese and mixed-race population, it is important to maintain a higher level of suspicion when prescribing allopurinol.
BackgroundCardio and cerebrovascular disease (CVD) and Alzheimer's Disease-Related Dementia (ADRD) significantly impact older adult populations, with interlinked pathways influencing risk and progression. In Hawaii, where over 20% of the population is 65 or older and ethnic diversity is among the highest in the U.S., the relationship between ADRD and CVD requires closer examination, especially concerning racial and socioeconomic factors.ObjectiveThis study aims to assess the effects of race, ethnicity, and socioeconomic status on the bidirectional risk pathways between ADRD and CVD among older populations in Hawaii.MethodsUtilizing a multistate modeling framework, we analyzed nine years of longitudinal Medicare data to track transitions between ADRD, CVD, and mortality outcomes. We investigated associations among racial and ethnic groups, including Native Hawaiian and other Pacific Islander (NHPI), Asian Americans (AA) and white populations, accounting for socioeconomic status to identify disparities in risk progression and outcomes.ResultsThe analysis revealed notable racial and socioeconomic disparities in the transitions between ADRD, heart disease (HD), Stroke, and mortality among Hawaii's older population. Overall, lower socioeconomic status indicates increased risks for transitioning to more severe clinical states and mortality. However, such effects were found to be varied among races: AA, NHPI, and whites. Our findings suggest that socioeconomic status modifies the ADRD, HD, Stroke progression dynamics across different ethnicities.ConclusionsThis study highlights the significant role of race/ethnicity and socioeconomic status in the complex progression of ADRD and CVD.
Angiostrongylus cantonensis is a globally distributed nematode and the leading cause of eosinophilic meningitis in humans. As a global hotspot for this disease, Hawaii's agricultural exports may be contributing to the spread of A. cantonensis. Phytosanitary irradiation doses of 150 or 400 Gy provide quarantine security against multiple insect pests. We evaluated the in vitro and in vivo effects of phytosanitary irradiation on infectious, third-stage, A. cantonensis larvae. In vitro experiments directly exposed larvae to irradiation doses ranging from 200 to 1,000 Gy. Results showed low mortality and no dose response across all treatments 27 days post-irradiation. In vivo studies isolated larvae from wild-caught Parmarion martensi after exposure to x-ray irradiation at doses of 0, 150, and 400 Gy and infected them into laboratory rats. Fourteen rats were assigned to each treatment and infected with 50 larvae from their assigned irradiation dose. Results at 3 and 6 weeks post-infection demonstrated a significant negative dose response in regard to the number of larvae that migrated to the brain and adults found in the pulmonary artery. No irradiated larvae that grew into adults were able to produce eggs. These findings indicate that x-ray irradiation does not result in the direct mortality of A. cantonensis larvae; however, it does affect the infectivity and reproduction of A. cantonensis within its definitive host, the rat. Phytosanitary irradiation at doses ≥150 Gy appears to be an effective means of preventing the establishment of viable populations of A. cantonensis, thus reducing the potential for global spread due to agricultural exports from Hawaii.
Introduction The recommendations on return to exercise post-traumatic brain injury (TBI) remain debatable. As recent as 10 years ago, the conventional recovery modality for a mild TBI was to reduce neurostimulating activity and encourage rest until the symptoms subsided. However, emerging literature has challenged this notion, stating that returning to exercise early in the course of mild TBI recovery may be beneficial to the recovery timeline. This study surveys Hawaii's diverse population to identify trends in exercise and recovery for TBI patients to shape recommendations on return to exercise. Methods A single-center retrospective chart review of the patients with mild-to-moderate TBI was selected from a patient database at an outpatient neurology clinic between January 2020 and January 2022. The variables collected include demographics, the etiology of injury, and symptoms at diagnosis. Self-generated phone surveys were completed to evaluate exercise patterns post-TBI. Results The patients who recovered within two years displayed similar exercise patterns to the patients who took more than two years to recover. Exercise frequency, intensity, and duration did not differ significantly (p=0.75, p=0.51, and p=0.80, respectively; n=100). Hiking and walking were more common in the long recovery (LR) group (p=0.02), likely reflecting advanced age compared to the short recovery (SR) group (50 versus 39 years, p<0.01). Additionally, no correlation exists between exercise intensity and worsening symptoms (p=0.920), suggesting that the patients exhibit exercise patterns suitable for sub-symptomatic recovery. Conclusion Return to exercise does not appear to be a predictor for mild-to-moderate TBI recovery. The patients appear to self-regulate an exercise regimen that will not exacerbate their symptoms or recovery time; thus, it may be suitable to recommend return to exercise as tolerated. These, and other findings in the literature, suggest that patients should be encouraged to return to exercise shortly after a mild TBI so long as the exercise does not exacerbate their symptoms.
Differential scanning calorimetry (DSC), a routine thermoanalytical method in material science, is gaining utility in plastic pollution research to improve polymer identification. We optimized a DSC method, experimentally testing pan types, temperature ramps, number of melts, and minimum sample masses. Using the optimized method, we created an in-house thermogram library from 201 polymer reference standards. We determined peak melting temperature cutoffs for differentiating variants of PE and nylon. PE cutoffs remained stable after experimentally weathering standards outdoors or for severely weathered HDPE debris found on Hawaii's beaches. Marine debris samples, across a range of weathering severity and previously identified as either low-density or high-density polyethylene (LDPE or HDPE) based on the 1377 cm-1 peak indicating methyl groups by attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR), were analyzed by DSC to confirm or challenge the ATR-FTIR PE differentiation. ATR-FTIR was correct for >80% of the HDPE samples, but <40% of those initially identified as LDPE by ATR-FTIR. Accuracy did not relate to weathering extent. Most samples mis-identified as LDPE were HDPE that had formed methyl groups likely from chain scission during photooxidation. ATR-FTIR alone is unreliable for differentiating weathered PE, DSC is required. We provide a multiple-method workflow for complete and accurate polymer identification, even for microplastics ≥0.03 mg. Applying these methods can better identify the polymer composition of marine debris, essential for sourcing and recycling efforts.
Current characteristics of early onset colorectal cancer (EOCRC) in the United States have been mainly studied in Whites, African Americans, and Hispanics, but little is known in regard to EOCRC in Asians and Native Hawaiians in the US. EOCRC was examined in Hawaii's multiethnic population. Data from the Hawaii Tumor Registry was used to analyze colorectal cancer (CRC) cases diagnosed in Hawaii from 2000-2019 by subsite, age, gender, ethnicity, and stage. Ethnicity analyses were limited to 3524 CRC cases, diagnosed between 2015-2019. Average annual 5-year age-adjusted incidence and mortality rates, average annual percent change over time, and 5-year survival were evaluated. Group comparisons utilized Chi-square and binomial proportion tests. Overall CRC incidence and mortality declined and were more pronounced for colon than rectal/rectosigmoid junction cancers. Colon cancer incidence rates significantly increased 1.46-fold for cases diagnosed under 45 years of age and rectal/rectosigmoid cancers significantly increased 1.54-fold for cases 45-54 years of age. CRC incidence increased sharply for females aged 45-54 years from 2000-2009 to 2010-2019, and increases in colon and rectal/rectosigmoid cancer among individuals aged 45-54 were higher for females. Among both sexes, the increase in rectal/rectosigmoid cancer incidence for individuals under 55 years was highest for stage I cancers. Overall, the mean (SD) age of CRC diagnosis was 5-10 years earlier for Native Hawaiians (60.6 [13.3] years) compared with Japanese, Chinese, Filipinos, Whites, and Other Asians (p < 0.001). Native Hawaiians constituted a greater proportion of CRC diagnosed under age 55 years and, conversely, a smaller proportion of cases 55 years and older compared with Japanese, Chinese, Filipinos, Whites, and Other Asians. Native Hawaiians had a significantly higher CRC-related mortality rate (14.5 per 100,000 [95% CI: 12.4, 16.8]) compared with Japanese (10.7 per 100,000 [95% CI: 9.3, 12.3]) and a significantly lower CRC survival rate (62.2% [95% CI: 59.1, 65.2]) compared with Japanese (71.9% [95% CI: 69.9, 73.8]), Filipinos (71.9% [95% CI: 69.2, 74.4]), Chinese (70.2% [95% CI: 65.5, 74.4]), Whites (69.3% [95% CI: 67.1, 71.4]), and Other Asians (71.7% [95% CI: 66.2, 76.5]). In our diverse US population, Native Hawaiians contribute disproportionately to EOCRC and present 5-10 years earlier than Whites, Japanese, Chinese, and Filipinos. EOCRCs are increasing faster in females than males in Hawaii, which differs from trends in the general US population. Emerging ethnic disparities in EOCRC in the US speak to the need for studies on targeted interventions and ethnic-specific risk factors for EOCRC.
Anthropogenic hybridization, or higher and non-natural rates of gene flow directly and indirectly induced by human activities, is considered a significant threat to biodiversity. The primary concern for conservation is the potential for genomic extinction and loss of adaptiveness for native species due to the extensive introgression of non-native genes. To alleviate or reverse trends for such scenarios requires the direct integration of genomic data within a model framework for effective management. Towards this end, we developed the simRestore R program as a decision-making tool that integrates ecological and genomic information to simulate ancestry outcomes from optimized conservation strategies. In short, the program optimizes supplementation and removal strategies across generations until a set native genetic threshold is reached within the studied population. Importantly, in addition to helping with initial decision-making, simulations can be updated with the outcomes of ongoing efforts, allowing for the adaptive management of populations. After demonstrating functionality, we apply and optimize among actionable management strategies for the endangered Hawaiian duck for which the current primary threat is genetic extinction through ongoing anthropogenic hybridization with feral mallards. Simulations demonstrate that supplemental and removal efforts can be strategically tailored to move the genetic ancestry of Hawaii's hybrid populations towards Hawaiian duck without the need to completely start over. Further, we discuss ecological parameter sensitivity, including which factors are most important to ensure genetic outcomes (i.e. number of offspring). Finally, to facilitate use, the program is also available online as a Shiny Web application.
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Alzheimer's disease (AD) and cardiovascular and cerebrovascular diseases (CVD) are significant concerns among the elderly, sharing overlapping risk factors. Hawaii's unique demographic profile, characterized by its strong ethnic diversity, shows marked racial health disparities. For instance, the Native Hawaiian/Pacific Islander (NHPI) population is identified as a high-risk group for multiple health conditions, including CVD. This study investigates the impact of AD on the risk of developing CVD, with a focus on racial influences, utilizing Hawaii Medicare data. Employing nine years of longitudinal Hawaii Medicare data, this study identified elderly patients diagnosed with AD who subsequently developed heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), or stroke. To assess the risk of CVD, we utilized multistate models and employed propensity score-matched controls. Additionally, we evaluated racial and ethnic differences in the risk of these diseases, while accounting for other relevant risk factors. Our findings revealed an elevated risk of AMI, HF, and IHD among individuals diagnosed with AD. Additionally, socioeconomic status (SE) was identified as a crucial factor in the risk of cardio and cerebrovascular diseases. Within the low SE group, NHPIs exhibited increased risks of HF and IHD compared to their white counterparts. Interestingly, NHPIs demonstrated reduced risks of HF in the higher SE group. The presence of AD increases the likelihood of developing AMI, HF, and IHD. Moreover, the risk of CVD appears to be influenced by race/ethnicity in Hawaii, as well as socioeconomic status.
Plasmodium parasites infect thousands of species and provide an exceptional system for studying host-pathogen dynamics, especially for multi-host pathogens. However, understanding these interactions requires an accurate assay of infection. Assessing Plasmodium infections using microscopy on blood smears often misses infections with low parasitemias (the fractions of cells infected), and biases in malaria prevalence estimates will differ among hosts that differ in mean parasitemias. We examined Plasmodium relictum infection and parasitemia using both microscopy of blood smears and quantitative polymerase chain reaction (qPCR) on 299 samples from multiple bird species in Hawai'i and fit models to predict parasitemias from qPCR cycle threshold (Ct) values. We used these models to quantify the extent to which microscopy underestimated infection prevalence and to more accurately estimate infection patterns for each species for a large historical study done by microscopy. We found that most qPCR-positive wild-caught birds in Hawaii had low parasitemias (Ct scores ≥35), which were rarely detected by microscopy. The fraction of infections missed by microscopy differed substantially among eight species due to differences in species' parasitemia levels. Infection prevalence was likely 4-5-fold higher than previous microscopy estimates for three introduced species, including Zosterops japonicus, Hawaii's most abundant forest bird, which had low average parasitemias. In contrast, prevalence was likely only 1.5-2.3-fold higher than previous estimates for Himatione sanguinea and Chlorodrepanis virens, two native species with high average parasitemias. Our results indicate that relative patterns of infection among species differ substantially from those observed in previous microscopy studies, and that differences depend on variation in parasitemias among species. Although microscopy of blood smears is useful for estimating the frequency of different Plasmodium stages and host attributes, more sensitive quantitative methods, including qPCR, are needed to accurately estimate and compare infection prevalence among host species.
Forensic taphonomy, the study of post-mortem processes, is pivotal in modern forensic science. This short communication illuminates limitations in traditional 2D imaging, specifically digital photographs, within forensic taphonomy, and highlights the vast potential of 3D modeling techniques. Drawing from a recent study in Hawaii's tropical savanna, we unveil disparities between real-time observations and 2D photographs when assessing decomposition, emphasizing the importance of scoring method selection and the need to scrutinize 2D imaging's accuracy in forensic taphonomy. Conversely, 3D modeling techniques, an emerging powerhouse in forensic science, offer multidimensional data, including volume, surface area, and spatial relationships, allowing for comprehensive and precise representation of decomposition dynamics. Despite concerns about texture quality, 3D models yield objective data amenable to analysis by multiple experts, thus minimizing subjectivity and augmenting the reliability of forensic assessments. The potential for 3D modeling to bridge the gap between 2D imaging and real-time decomposition requires tailored methodologies. Future research should focus on standardizing protocols and fostering collaboration among forensic experts, technologists, and researchers to unleash 3D technology's full potential in advancing forensic taphonomy.
Hawai'i experiences some of the highest rates of houselessness per capita in the country. COVID-19 has exacerbated these disparities and made it difficult for these individuals to seek medical care. Hawai'i's Houseless Outreach in Medical Education (HOME) clinic is the largest student run free clinic in the state, which provides medical services to this patient population. This article reports the demographics, medical needs, and services provided to patients of Hawai'i's HOME clinic during the era of COVID-19. From September 2020 to 2021, the HOME clinic saw 1198 unique visits with 526 distinct patients. The most common chief complaints included wound care (42.4%), pain (26.9%), and skin complaints (15.7%). A large portion of the population suffered from comorbidities including elevated blood pressure (66%), a formal reported history of hypertension (30.6%), diabetes (11.6%), and psychiatric concerns including schizophrenia (5.2%) and generalized anxiety (5.1%). Additionally, a large portion of patients (57.2%) were substance users including 17.8% of patients endorsing use of alcohol, 48.5% tobacco and 12.5% marijuana. The most common services provided were dispensation of medication (58.7%), wound cleaning/dressing changes (30.7%), and alcohol or other drug cessation counseling (25.2%). This study emphasizes that the houseless are a diverse population with complex, evolving medical needs and a high prevalence of chronic diseases and comorbidities.