Digital Commons Network^™

Urban Areas Are Associated With Earlier Breeding Timing In American Robins, Lola Hackle, Jennifer Wickes, Elise Mittlestat, Ashley Stine, Keegan Abeson, Carolina Villalona, Mikus Abolins-Abols

The Cardinal Edge

Climate change and urban environment have been shown to affect bird reproductive timing. In particular, urban development can create the so-called “heat islands” – urban areas that are hotter than the surrounding environment. While the primary cue birds use to time their reproduction is daylength, birds also use temperature as a supplementary cue to fine-tune their reproductive timing. Change in the timing of breeding may impact the survivability of nestlings due to temperature fluctuations and food availability. The American Robin (Turdus migratorius) is a widespread songbird in North American cities and rural areas. We sought to see if urban heating …

The Effect Of Prenatal Cigarette Smoke Exposure And Adult High-Fat/High-Fructose Diet On Liver Triglyceride Levels, Toni A. Adedokun, Isaiah Burciaga, Megan Jacobs, Katelyn Chism, Anna-Lee Harris, Kristen Overton, Selma Podbicanin, Andrew Potts, Rachel Neal, Cynthia Corbitt

The Cardinal Edge

Prenatal cigarette smoke exposure (CSE) is associated with chronic metabolic disease in adulthood, including obesity, type 2 diabetes, and metabolic dysfunction-associated fatty liver disease. Maternal cigarette smoking reduces uterine and placental blood flow, limiting nutrients and oxygen supply to the fetus. According to the Developmental Origins of Health and Disease hypothesis, these conditions may cause developmental adaptations that are maladaptive in calorie-rich environments. We hypothesized that gestational CSE would sensitize affected offspring to the effects of an adulthood high-fat (40 kcal%), high fructose (20 kcal%) diet. C57BL/6J mice were exposed either to filtered room air (sham) or the smoke generated …

Hallucinogens For Mood And Anxiety Disorders: A Critical Review Of Psychedelic-Assisted Therapies, Georgia Chlebek

The Cardinal Edge

In quite a few people worldwide, there are several mental disorders that prevent the brain from operating in the “proper” way, depression, anxiety, and post-traumatic stress disorder (PTSD) being among the most common. Luckily, there are several medications that are produced and used to treat these disorders, but some medications are hard to access, and others simply don’t help the patient. Firstly, these medications take time to study and prove safe for public use, though in some cases time is not readily available. In other cases, these medications are going through shortages and becoming increasingly difficult for patients to access …

Leaf Droppage Delayed In Sugar Maple Trees On An Urban To Rural Gradient, Isabella S. Bastien, Isabella Bastien

The Cardinal Edge

This study investigates the timing of leaf abscission in Sugar Maple (Acer saccharum) trees along an urban-to-rural gradient in Louisville, Kentucky, to determine how proximity to urban environments influences leaf drop. We hypothesized that urban trees would retain their leaves longer than suburban or rural trees due to environmental stressors and tested this using weekly leaf collection and canopy cover measurements from three locations—urban, suburban, and rural. Results showed that urban trees exhibited delayed leaf drop and slower canopy opening compared to suburban and rural trees. These findings suggest that urban stressors significantly alter tree phenology, which may signal underlying …

Disrupted Nuclear Function And Nucleocytoplasmic Transport In Parkinson’S Disease, Ichiro M. Matoba

The Cardinal Edge

No abstract provided.

Asimina Triloba (L.) Dunal: The Complete Story Of America’S Forgotten Fruit, Autumn M. Howard

The Cardinal Edge

Asimina triloba, commonly known as the pawpaw, is a unique and historically significant native fruit tree of the eastern United States. This research paper explores the taxonomy, botanical description, distribution, habitat requirements, ecological interactions, economic importance, and reproductive biology of A. triloba. The species is distinguished by its tropical-flavored fruits, adaptation to temperate climates, and reliance on clonal reproduction and specific insect pollinators. While offering promising opportunities for sustainable agriculture and riparian restoration, A. triloba faces challenges related to limited seed dispersal, susceptibility to certain pests and diseases, and the presence of neurotoxic compounds. Despite its historical importance …

Lamin A/C And Linc Complex Expression Affects Nuclei's Mechanical Properties And Functions In Osteosarcoma, Shridha Rajeswar

The Cardinal Edge

The nucleus has long been simplified in the field of biology, despite being an important organelle. Until recently, it has been commonly depicted as a simple sphere located at the center of a cell, responsible mainly for regulating protein synthesis. However, current research indicates that the linkers of the nucleoskeleton and cytoskeleton (LINC) complexes, the pillars of nuclear architecture, play a critical role in maintaining nuclear integrity and function. These complexes interact with proteins, such as Lamins, that modulate responses to biomechanical stimuli through the regulation of gene expression. As such, when these structures are downregulated, they can contribute to …

Crepe Myrtle Bark Scale (Acanthococcus Lagerstroemiae) And Sooty Mold (Capnodium Sp.) Decrease Bloom And Fruit Number In ‘Natchez’ Crepe Myrtle (Lagerstroemia Xfauriei ‘Natchez’), Derald A. Harp, Beatriz Ruiz, Kara Bailey, Pedro Castillo, Phoebe Alvarez

Faculty Publications

Crepe myrtle bark scale (CMBS) (Acanthococcus lagerstroemiae) is an important pest of crepe myrtle in Texas, and infestations are accompanied by excessive growth of sooty mold (SM) that will cover stems, and, in severe cases, leaves. These combine to create significant stress on the plant, and anecdotal evidence suggests a decrease in bloom number under heavy infestation. In an existing planting of 24 ‘Natchez’ crepe myrtle in four blocks, three trees were randomly chosen in each block and treated with either a dinotefuran (year 1) or imidicloprid (year 2) drench. The three remaining trees were untreated. In February of year …

The Dual-Specificity Phosphatase Jsp1 Regulates Neutrophil Adhesion Via Integrin-Src Signaling In Vascular Inflammation, Li Li

BCES: Faculty Publications

The c-JUN N-terminal kinase (JNK) signaling pathway plays an important role in regulating the innate immune response. Immune signaling is governed by the coordinated activity of protein kinases counter-balanced by protein phosphatases; however, the importance of the latter family of enzymes is less well understood. c-JUN N-terminal kinase (JNK)-stimulatory phosphatase 1 (JSP1, also known as DUSP22) has been implicated as a positive regulator of JNK signaling, yet its role in innate immunity is not clear. Using a mouse model of the local Shwartzman reaction, we show that JSP1 is essential for LPS-TNF-alpha-induced vascular injury. JSP1-knockout mice exhibited reduced vascular hemorrhage. …

Ifnγ-Induced Antigen Loss In Chimeric Antigen Receptor-T Cell Therapy, Miao Cao, Jasmine Alvarez, Ramkrishna Mitra, Michael Xu, Trevor R. Baybutt, Zhengyang Sun, Oluwatobiloba Taylor, Allison Doermann, Ross E Staudt, Scott A. Waldman, Adam E. Snook

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

INTRODUCTION: FDA-approved chimeric antigen receptor (CAR)-expressing T cell therapies (CARTs) have revolutionized the treatment of blood cancers. Yet none have been successful for "solid" tumors, such as colorectal cancer (CRC), the 2nd leading cause of cancer deaths. Guanylyl cyclase C (GUCY2C) has emerged as a clinical-stage target for CART and bispecific T-cell engager (BiTE) therapies in CRC. IFNγ has been canonically recognized as beneficial for the effector functions of T cells by enhancing antigen processing and HLA presentation and is essential for CART targeting of solid malignancies by inducing adhesion molecule expression for synapse stabilization.

METHODS: Using

RESULTS: We identified …

Cannibalism, Predation, And Refuges Of Juvenile Blue Crabsfrom A 37–Year Experiment, Anson H. Hines, Margaret A. Kramer, Kimberly D. Richie, L. David Smith, Robert Aguilar, Matthew B. Ogburn, Eric G. Johnson, Gregory M. Ruiz

Biological Sciences: Faculty Publications

This 37-y record (1989–2025) of field experiments tested seasonal and annual variation in predation on juvenile blue crabs (Callinectes sapidus) in a representative mesohaline site of Chesapeake Bay, USA, where the species is a dominant epibenthic predator and major fishery. We used replicated sets of individually tethered crabs to provide a relative index of lethal and sublethal predation rates on intermolt individuals as a function of size and habitats. Cannibalism by large adult crabs accounted for>97% of predation of juvenile crabs; predation by fish was not observed; and mortality from physiological stress was rare (< 1%). Sampling by depth showed that juveniles occurred in nearshore shallows, while adults were in deeper water. Cannibalism was also depth-dependent: Rates were high at 75 cm depth; intermediate at 40cm; and lowest at 15 cm shallows, which provided partial refuge. Cannibalism was size-dependent: 30 to 50 mm juveniles experienced high rates of predation; 90 to 110mm preadults had low rates; and >120 mm adults …

Black Medic (Medicago Lupulina) Identification And Control In Residential Landscapes, Michael Caron, Taun Beddes, Corey Ransom

All Current Publications

Black medic (Medicago lupulina) is an herbaceous winter or summer annual broadleaf landscape weed. This fact sheet provides a weed description and describes suppression and control options.

Seasonal Dynamics And Trends Of Environmental Conditions In Lake Louise, Georgia, Daniel Kwawuvi, James A. Nienow

Georgia Journal of Science

Lakes are important aquatic ecosystems that are extensively influenced by seasonal variations. In this study we investigate the seasonal dynamics and trends of three environmental variables, water temperature, conductivity and dissolved oxygen (DO), in Lake Louise, a sinkhole lake located in southern Georgia. These variables were measured in-situ along a depth profile from January 27, 2024 to January 17, 2025. We also accessed archived data from field campaigns in 2003, 2004, and 2017 in order to test whether a recent increase in the number of hurricanes impacting the region, five since August, 2017, may have significantly altered the seasonal dynamics …

Characterisation Of Pouch Secretions From Breeding Tasmanian Devils, Manujaya W. Jayamanna Mohottige, Emma Peel, Angéla Juhász, Mitchell G. Nye-Wood, Katherine Belov, Michelle L. Colgrave, Carolyn J. Hogg

Research outputs 2022 to 2026

Tasmanian devils (Sarcophilus harrisii), like all marsupials, give birth to altricial young. Here we employ proteomic analysis to identify components of devil pouch secretions that may contribute to offspring survival and development. Proteins were extracted from five samples and analysed by liquid chromatography-tandem mass spectrometry. Peptide-level evidence revealed proteins involved in a diverse set of immune pathways, including those mediating iron-ion transport, defence responses to bacteria, innate immune responses, and antigen processing. A core set of 200 proteins was identified across at least three samples, 63 of which were associated with antimicrobial or immunoregulatory functions. These included immunoglobulins, components of …

Radiation Doses To Cardiac Substructures Predict Elevation In High-Sensitivity Cardiac Troponin T Levels In Radiation Therapy For Lung Cancer, Xinru Chen, Xiaodong Zhang, Ting Xu, Radhe Mohan, Ruitao Lin, Mei Chen, Rachel C Maguire, Yao Zhao, Efstratios Koutroumpakis, Nicolas L Palaskas, Anita Deswal, Ali Ajdari, Joshua S Niedzielski, Sanjay S Shete, Laurence E Court, Jinzhong Yang, Zhongxing Liao

Faculty, Staff and Student Publications

Purpose: Cardiotoxicity is a major concern for patients undergoing thoracic radiation therapy. This study compared the predictive power of radiation dose-volume histogram (DVH) parameters and radiomic/dosiomic features of the whole heart (WH) and cardiac substructures for elevated circulating high-sensitivity cardiac troponin T (hs-cTnT), a biomarker for early detection of cardiac adverse events.

Methods and materials: A retrospective cohort of 160 patients with non-small cell lung cancer (NSCLC) from a completed prospective trial and a prospective cohort of 57 patients with NSCLC enrolled in an ongoing trial were analyzed. The endpoint was hs-cTnT elevation, indicated by an increase of ≥5 ng/L …

High Dietary Fiber Is Associated With Improved Outcomes In Patients With Melanoma And Sarcoma Treated With Immunotherapy Regardless Of Gut Microbiome Dysbiosis And Social Vulnerability, Brittany C Fields, Raymond S Traweek, Kai Jiang, Russell G Witt, Ashish Damania, Yi-Ju Chiang, Nadim Ajami, Elise Nassif-Haddad, Emily Z Keung, Manoj Chelvanambi, Xiaotao Zhang, Christine B Peterson, Jennifer A Wargo, Carrie R Daniel, Christina L Roland, Ashley M Holder

Faculty, Staff and Student Publications

Background: Social vulnerability, dietary fiber, and the gut microbiome have been individually implicated in clinical outcomes for melanoma and sarcoma patients. This study hypothesized that increasing social vulnerability is associated with insufficient dietary fiber intake and negatively associated with microbiome composition and clinical outcomes.

Methods: Clinicopathologic data, baseline fiber intake, and gut microbiome profiles were assessed in 153 patients with melanoma or sarcoma treated with immune checkpoint blockade (ICB) and prospectively followed. Patients' social vulnerability index (SVI) and fiber intake were evaluated for associations with microbiome composition, treatment response, and overall survival (OS).

Results: SVI percentile was 0.4 (interquartile ratio …

Simulated Hearing Loss In Healthy Young And Older Adults Results In Poor Reaction Time In Older Adults., Victoria Kowalewski, Nicoleta Bugnariu, Rita M. Patterson, Jessica Hartos

Pacific Journal of Health

Emerging evidence links hearing loss to increased fall risk in older adults, yet mechanisms remain unclear. This study examined the impact of simulated hearing loss on reactive balance control in healthy young and older adults. Participants performed dual-task scenario involving auditory sentence repetition and unexpected surface translations. Hearing loss was simulated using Adobe Audition, applying frequency-specific attenuation based on moderate sensorineural hearing loss levels from the literature.

Speech-in-noise performance significantly declined under simulated hearing loss for both age groups (p < .001), confirming effective simulation, but not significant differences were found between age groups. Maximum COP-COM displacement (the scalar distance between Center of Pressure and Center of Mass) increased with perturbation intensity (Level 1 vs. Level 2: p < .001), but no significant differences were found between hearing conditions or age groups (p > .05), suggesting compensatory step execution was preserved.

Reaction time analysis revealed a significant interaction between hearing condition and perturbation level …

A Distributed Model For Undergraduate Education In Environmental Remote Sensing: Increased Student Interest In Science And Sense Of Science Identity And Belonging, Gregory R. Goldsmith, Monae Verbeke, Jeremy Forsythe, Joshua B. Fisher

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

"We present results from a new open-access course in satellite remote sensing of the environment that uses evidence-based, active learning pedagogy to train the next generation of interdisciplinary scientists The course, called Observing Earth from Above, teaches students how to access, visualize, and communicate satellite remote sensing data from NASA’s ECOSTRESS instrument to address a variety of environmental challenges. The resources focus on follow-along tutorials for students and also include recorded lectures and interviews with remote sensing scientists."

Advancements In Extracellular Vesicle Research, Lucia R. Languino

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

The AAEV (American Association of Extracellular Vesicles) Annual Meeting at the John P. McGovern Commons in Houston, TX convened over 300 leading re- searchers, clinicians, and industry experts from around the world to advance the rapidly evolving field of extracellular vesicle (EV) science. EVs, nanoscale lipid- bound particles released by all prokaryotic and eukaryotic cells, have emerged as crucial mediators of intercellular communication, trans- porting proteins, nucleic acids, and lipids that influence a wide spectrum of physiological and pathological processes. Their involvement in immune modulation, tissue regeneration, cancer progression, metabolic regulation, and other complex biological functions positions EVs as promising …

Analysis Of Traditional Wisdom For Ecological Sustainability In Tanzania: A Case Study Of Metaphorical Source Domains In Pangwa Ritual Texts, Winne Stephen Mtega, Angelus Mnenuka

Journal of Humanities and Social Sciences

Campaigns for ecological sustainability have gained a great currency in the contemporary academic discourse. Nonetheless, from time immemorial, Africans have pushed the ecological sustainability agenda through cultural taboos and regulated resource harvesting. Many African societies have embedded ecological consciousness in daily life expressions, and have intricately expressed it through literary and ritual texts. This study focuses on ecological awareness in the ritual texts of the Pangwa community. It analyses how environmental domains—such as land, seeds, and fruits—serve as the basis for metaphors in the Pangwa community to prove the use of wisdom to promote and sustain ecological practices (ecocriticism). The …

Larvicidal Activity Of Β-Asarone And Acorus Calamus Linn. (Sweet Flag) Extract Against Aedes Aegypti (Dipotera: Culicidae): Enzyme Inhibition, Midgut Histopathology, And In Silico Analysis, Rizal Subahar, Surya Dwira

Indonesian Journal of Medical Chemistry and Bioinformatics

Aedes aegypti (Diptera: Culicidae), the primary vector of dengue, poses a significant public health threat in tropical and subtropical regions. Botanical insecticides and phytochemicals such as β- asarone, derived from essential oils,offer a promising alternative to synthetic larvicides. The rhizome of Acorus calamus L. (sweet flag), traditionally known for its neuroprotective and antioxidant properties, contains β-asarone as its principal bioactive constituent.This study evaluated the larvicidal efficacy of β-asarone and A. calamus rhizome extract against Ae. aegypti larvae, focusing on detoxification enzyme inhibition, midgut histopathology, and in silico molecular interactions.Third- and fourth-instar larvae were exposed to β-asarone and crude extract at …

Ionic Liquid Pilocarpine Serves As Therapeutic Cosolvent And Permeation Enhancer For Glaucoma Medication, Ashish Trital, Lei Xu, Burhan Ates, Tzu Chen Wang, Vimalin Mani, Hu Yang

Chemical and Biochemical Engineering Faculty Research & Creative Works

The efficacy of hydrophobic ocular drugs is significantly hindered by their low bioavailability, for which poor water solubility is a major contributing factor. In this work, we synthesized pilocarpine-derived ionic liquid [Pilo-OEG] Cl (PO) and evaluated its cosolvent properties for the codelivery of the hydrophobic antiglaucoma drug brimonidine (BM) for glaucoma therapy. Pilocarpine was quaternized with 2-[2-(2-chloroethoxy) ethoxy] ethanol in a one-pot reaction to yield PO, and its structure was confirmed using ¹H NMR and FT-IR spectroscopy methods and further characterized for its rheological property and thermal stability. The HET-CAM assay and cell viability study showed that PO was …

The Sortee Guidelines For Data And Code Quality Control In Ecology And Evolutionary Biology, Joel L. Pick, Bethany J. Allen, Benedicte Bachelot, Kevin R. Bairos-Novak, Jack A. Brand, Barbara Class, Tad Dallas, Pietro B. D'Amelio, Erola Fenollosa, Esteban Fernández-Juricic, Dylan G. Gomes, Matthew J. Grainger, Thomas Guillemaud, John Christian, Ruby Krasnow, Malgorzata Lagisz, Sebastian Lequime, Daniel S. Maynard, Shinichi Nakagawa, Rose E. O'Dea, Et. Al.

Faculty Publications

Open data and code are crucial to increasing transparency and reproducibility, and in building trust in scientific research. However, despite an increasing number of journals in ecology and evolutionary biology mandating for data and code to be archived alongside published articles, the amount and quality of archived data and code, and subsequent reproducibility of results, has remained worryingly low. As a result, a handful of journals have recruited dedicated data editors, whose role is to help authors increase the overall quality of archived data and code. There is, however, a general lack of consensus around what a data editor should …

Unraveling Metabolic Determinants Of Isoniazid Susceptibility In Mycobacterium Tuberculosis, Erin Rilu Wang

Arts & Sciences Graduate Student Theses and Dissertations

Mycobacterium tuberculosis (Mtb) causes the disease tuberculosis (TB) and is one of the leading causes of death worldwide by an infectious agent. Furthermore, the emergence and evolution of drug resistance has significantly hindered global health efforts to combat this deadly epidemic. Thus, there is a critical need for development of new antibiotics with unique mechanisms of action and design of novel strategies for optimizing the efficacy of existing therapeutic regimens. It is estimated that 10.7% of new infected and 27.2% of previously treated TB cases are resistant to the frontline antibiotic isoniazid (INH), a central component of TB chemotherapeutic regimens. …

Tiger Shark (Galeocerdo Cuvier) Jaw, Nicholas D. Burchett, Jade Mells, David W. Kerstetter

All Scans: Kerstetter Fisheries and Avian Ecology 3D Scan Series

No abstract provided.

Blue Shark (Prionace Glauca) Jaw, Nicholas D. Burchett, David W. Kerstetter

All Scans: Kerstetter Fisheries and Avian Ecology 3D Scan Series

No abstract provided.

Gastrointestinal Symptoms After Sport-Related Concussion In Irish Athletes, Emma Finnegan, Ed Daly, Katherine Hunzinger, Lisa Ryan

Department of Exercise Science Faculty Papers

Background/Objectives: Sport-related concussion (SRC) elicits multi-systemic symptoms, including nausea, fatigue, and cognitive changes. Gastrointestinal (GI) symptoms are not well captured in current concussion assessments and may be under-recognised in clinical follow-up. GI disturbances may influence intake tolerance and day-to-day fuelling during post-SRC recovery. This study investigated the prevalence and severity of self-reported GI symptoms in Irish athletes after their most recent SRC, examined sex-based patterns, and evaluated the rationale for integrating GI symptom checks into standard concussion tools (e.g., SCAT6) and post-injury monitoring. Methods: An online survey was completed by recreational, competitive, and elite athletes who retrospectively self-reported concussion history, …

Breaking Into Hiv-1'S Epigenetic Vault: Cure Strategies To Eliminate The Viral Reservoir, Joanna Jones, Chelsea Gunderson, Brian Wigdahl, Michael Nonnemacher

Kimmel Cancer Center Faculty Papers

Human immunodeficiency virus type 1 (HIV-1) is a retrovirus that integrates into the host cell's DNA as a provirus. Transcription from the provirus is regulated in large part by cellular proteins and epigenetic factors. These may be repressive or permissive to productive infection. The host factors that regulate this balance are therefore attractive targets for HIV-1 therapeutics. Indeed, proviral chromatin is the focus of two of the current HIV-1 cure strategies. "Shock and Kill" uses latency reversal agents to open the provirus's chromatin, promoting high levels of gene expression that induce the killing of infected cells. "Block and Lock" uses …

Uncovering Hidden Prognostic Patterns In Colorectal Cancer Histology Using Unsupervised Learning: A Computational Pathology Study, Wen-Tong Zhou, Yong Liu, Gang Yu, Kuan-Song Wang, Chao Xu, Jonathan Greenbaum, Chong Wu, Lin-Dong Jiang, Christopher J Papasian, Hong-Mei Xiao, Hong-Wen Deng

Faculty, Staff and Student Publications

Colorectal cancer (CRC) remains a leading cause of cancer mortality globally, yet current histopathological diagnostics capture only limited features. This study aimed to discover subtle, prognostically significant histomorphological patterns in CRC tissues using unsupervised deep learning. We developed a framework integrating convolutional neural networks with deep clustering, trained on 23,341 image patches from 493 patients. We identified 30 distinct histomorphological clusters from CRC tissue images. Through univariate and multivariate survival analyses, three clusters (Cluster13, Cluster19, and Cluster24) were consistently associated with patient prognosis. These clusters were integrated with clinical factors (T stage, N stage, and differentiation degree) to construct a …

Telemedicine As A Gateway To Early-Phase Oncology Trials: Lessons From 14,000 Patients And Future Directions For Global Access And Equity, Carlos Torrado, Clark R Andersen, Lei Kang, Amanda L Brink, Taiwo Adesoye, Hung Le, Clover J Patterson, Anna Poullard, Jessica A Osburn, Harold N Tan, Mohamed A Gouda, Sheena Charles, Gabriele E Urschel, Tin-Yun Tang, David S Hong, Stephane Champiat, Aung Naing, Apostolia M Tsimberidou, Ecaterina E Dumbrava, Sarina A Piha-Paul, Jordi Rodon, Timothy A Yap, Paula R Pohlmann, Funda Meric-Bernstam, Siqing Fu

Faculty, Staff and Student Publications

Background: Telemedicine expanded rapidly during the COVID-19 pandemic, but its role in early-phase oncology trials remains uncertain. We evaluated its impact on recruitment, enrollment, equity, and access in a large phase I program.

Patients and methods: We retrospectively analyzed patients seen for first consultation in the MD Anderson Phase I Program (2016-2023). Recruitment (consent) and enrollment (treatment initiation) were compared by visit type, race/ethnicity, and geography across pre-pandemic (2016-2019), pandemic (2020-March 11, 2023), and post-public health emergency (PHE; March-December 2023) periods. A chart review of 400 patients validated findings.

Results: Of 14,085 patients, 7,247 were evaluated post-pandemic, with 36% (n …