Digital Commons Network^™

Translational Framework Linking Perfluoroheptanoic Acid (Pfhpa) Exposure To Metabolic Dysfunction Associated Steatotic Liver Disease In Adolescents, Brittney O Baumert, Ana C Maretti-Mira, Douglas I Walker, Zhenjiang Li, Nikos Stratakis, Hongxu Wang, Yinqi Zhao, Fabian Christoph Fischer, Qiran Jia, Damaskini Valvi, Scott M Bartell, Jiawen Carmen Chen, Thomas Inge, Justin R Ryder, Todd Jenkins, Stephanie Sisley, Stavra Xanthakos, David E Kleiner, Rohit Kohli, Sarah Rock, Sandrah P Eckel, Michele A La Merrill, Max M Aung, Matthew P Salomon, Rob Mcconnell, Jesse Goodrich, David V Conti, Lucy Golden-Mason, Lida Chatzi

Faculty, Staff and Students Publications

Background: The rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), particularly among pediatric populations, requires identification of modifiable risk factors to control disease progression. Per- and polyfluoroalkyl substances (PFAS) have emerged as potential contributors to liver damage; however, their role in MASLD remains underexplored. This study aimed to develop a translational framework integrating human and in vitro data to elucidate the effect of PFAS on MASLD development.

Methods: We measured PFAS plasma levels in the Teen-LABS cohort (n = 136), comprising adolescents with obesity (mean age = 16.8 years) undergoing bariatric surgery. Plasma samples were also analyzed using proteomic …

Embracing Artificial Intelligence And Digital Health In Cancer Care, Pavitra P. Krishnamani

Advances in Cancer Education and Quality Improvement

Digital health technologies like AI, telemedicine, and wearables are revolutionizing cancer care by enabling earlier detection, personalized treatment, and improved patient support and access.

Interactive Clinical Dashboard For Psychiatric Oncology Services At A Cancer Institution: A Quality Initiative, Maria Shabih, Adelita D. Martinez, Alan D. Valentine, Deepti A. Chopra

Advances in Cancer Education and Quality Improvement

Accurate documentation of reasons for psychiatry consultations is critical for developing an effective treatment plan for the patient and improving quality of care through targeted interventions. The purpose of this project was to create an interactive dashboard on Power BI. We downloaded the report from Epic on SAP BI. On an Excel sheet, we recoded the reason for consults and categorized using a keyword list and recoded the consults into distinct, categories such as "anxiety," "depression," and "altered mental status (AMS)," with data spanning 2 fiscal years.

Key findings from the dashboard revealed that anxiety and depression accounted for most …

Designing An Electronic Patient-Reported Outcomes Information Infrastructure Supported By The Re-Aim Implementation Framework, Amy C. Moreno, Angela Peek, Toshiko S. Stein, Kevin R. Shook, Sara M. Ali, Laia Humbert-Vidan, Aileen Chen, Miriam Lango, Anna Lee, Michael Spiotto, William H. Morrison, Adam S. Garden, Jack Phan, Steven J. Frank, Katherine Hutcheson, David I. Rosenthal, Clifton D. Fuller, G Brandon Gunn

Advances in Cancer Education and Quality Improvement

Objective: Patient-reported outcomes (PROs) contain valuable information that can be leveraged by providers to perform timely interventions and improve quality of life and survival. However, the implementation of electronic PROs (ePROs) remains a challenge from technical and evaluation perspectives. Our objective was to construct a robust electronic health record (EHR)-integrated ePRO information infrastructure founded on RE-AIM (reach-effectiveness-adoption-implementation-maintenance) principles.

Materials and Methods: We used Epic Systems as our EHR platform to build the MD Anderson Symptom Index Head and Neck Module (MDASI-HN) for release to all patients undergoing evaluation and/or treatment in our HN Radiation Oncology clinics. RE-AIM metrics were …

Exploring Patient Perspectives On The Availability And Demand For Patient-Friendly Resources In Non-Small Cell Lung Cancer, Danielle Brazel, Aakash Desai, Fawzi Abu Rous, Jill Feldman, Eric Singhi

Advances in Cancer Education and Quality Improvement

Introduction: The growing emphasis on patient-centered care, along with the rise of open-access publications and online platforms, has increased patient demand for education about their medical conditions. In this context, patient-friendly language summaries of fundamental cancer clinical trials may be valuable resources for patients to learn more about their disease and treatment options.

Methods: We surveyed patients diagnosed with non-small cell lung cancer (NSCLC) to assess the availability and need for easy-to-understand resources related to treatment decision-making and side effect profiles. Patients were also provided an example patient-friendly language summary and asked for feedback.

Results: One hundred fourteen patients responded …

The Use Of Firgun To Improve Burnout And Workplace Civility In A Pediatric Cancer Center, Karen Moody, Jerry Stein, Deena Levine, Arshia Madni, Clark R. Andersen, Amy Heaton, Alakh P. Rajan, Demetrios Petropoulos, Jian Wang, Deborah Kramer

Advances in Cancer Education and Quality Improvement

Burnout afflicts 35% to 44% of pediatric oncology physicians, nurses, and interprofessional staff and is related to excessive workloads and emotional exhaustion. Conversely, a healthy work environment is a protective factor for burnout among physicians and nurses. Meaningful recognition is a published standard necessary for creating a healthy work environment. This study aimed to reduce staff burnout through firgun, defined as a heartfelt way to express accomplishments of another person. Pediatric oncology staff completed a firgun educational module and logged acts of firgun during a 3-month study period. Validated measures assessing burnout, workplace civility, well-being, work-life balance, and perceived …

Cd5 Expression In Ctcl And Its Implications For Anti-Cd5 Car T-Cell Therapy, Leena Wardeh, Madeline Williams, Courtney Prestwood, Zachary Wolner, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

Cutaneous T-Cell Lymphomas (CTCL) are a heterogenous group of T-cell malignancies in the skin and have poor treatment outcomes in advanced stages. CD5, a surface glycoprotein expressed on most mature T cells, has emerged as a promising target for chimeric antigen receptor (CAR) T-cell therapy in systemic T-cell lymphomas. However, its expression profile in CTCL and relevance for targeted therapy remain unclear. Notably, in CTCL, the cell surface expression of receptors, such as CD7 and CD26, tends to become downregulated on the surfaces of malignant T cells In this study, we analyzed single-cell RNA sequencing (scRNA-seq) data from patients at …

Single Local Injection Of 3s-Hmgb1 Enhances Early Bone Healing And Titanium Implant Osseointegration In Type 2 Diabetic Mice, Bhuvana L. Chandrashekar, Alexandra Arteaga, Evelin Rios, Jimena Mora, Gustavo P. Garlet, Danieli Rodrigues, Cláudia Cristina Biguetti

School of Podiatric Medicine Publications

Diabetes significantly impairs bone healing via several mechanisms, including sustained inflammation, oxidative stress, and poor osteogenic responses. Fully reduced isoform of High Mobility Group Box 1 with three serine substitutions (3S-HMGB1) has shown regenerative properties while being resistant to oxidative degradation.

Objective: This study evaluated the therapeutic potential of a single local injection of 3S-HMGB1 in early osseointegration under diabetic conditions in mice.

Methodology: A total of 48 male 129/Sv mice (24 non-diabetic [ND], 24 diabetic [D]) received titanium implants following maxillary first molar extraction. ND and D mice (n:12) were injected with either saline (control) or 3S-HMGB1 (0.75 mg/kg) …

A Structured, Competency-Based Framework For Aspiring Cardiothoracic Surgeons, Adham Ahmed, Samantha Colon, Gianna J. Dafflisio, Purab Kothari, Nina Uzoigwe, Alice Zhou, Juli Buchwald, Betemariam Sharew, Carter Glenn, Steven Medvedovsky, Justin Olivera, Ryan Kramer, Gabrielle Colon, Jonathan M. Tomasko, Sara J. Pereira, Mara Antonoff, Marc Pelletier, Irbaz Hameed

Student Papers, Posters & Projects

OBJECTIVE: Cardiothoracic surgery requires mastery of a broad knowledge base and advanced skillset to manage critically ill patients. Although competency-based assessment frameworks have been developed in several specialties, there remains a paucity of resources to guide practical progression for early cardiothoracic surgical trainees.

METHODS: Members of the Thoracic Surgery Residents Association, Thoracic Surgery Medical Student Association, and attending cardiothoracic surgeons with a strong track record of surgical education were invited to share their insights and experiences. A structured, milestone-driven roadmap was developed on the basis of their contributions.

RESULTS: We developed a structured, competency-based framework for early surgical trainees, with …

Decreasing Barriers To The Utilization Of Cryopreserved Sperm In Male Cancer Survivors: An Expert Review And Guide, Megan V Alexander, Hailie Ciomperlik, Anna Claire Reynolds, Allyson Nevins, Luwam Ghidei, Jordan Kassab, Kevin Campbell, John Sullivan, Michael D Jochum, Laura Detti, Terri L Woodard, Larry I Lipshultz, Laurie J Mckenzie

Faculty, Staff and Students Publications

Cryopreservation of sperm offers male cancer patients a critical opportunity to preserve fertility prior to gonadotoxic treatments. Despite its increasing availability, utilization rates remain modest at typically less than ten percent. This expert review provides a framework for an optimal Oncofertility Patient Care Pathway, explores the multifaceted barriers to cryopreserved sperm use, and proposes specific solutions. We focus on key timepoints for intervention, including the post-treatment fertility care return visit, continued sperm cryopreservation while remote from family building, eventual readiness for family building, and posthumous considerations. Patients often face difficulty engaging in post-treatment reproductive follow-up, with one-third of patients missing …

Creation And Evaluation Of Standardized Electronic Health Record Templates For Transition Of Care In Sickle Cell Disease: A Pilot Study, Stephanie Howe Guarino, Mohan Madisetti, Payal C. Desai, Akshat Jain, Kenneth Rivlin, Jerome A. Osheroff, Robin Miller, Brandi Campanella, Sophie Lanzkron, Julie Kanter

Cardeza Foundation for Hematologic Research

Objective The objective of this pilot project was to create a standardized Transition Note in the electronic health record (EHR) to facilitate clinician communication during the transition process from pediatric to adult care for youth with sickle cell disease (SCD). Methods Using a modified Delphi process, consensus was reached among 78 member centers from the National Alliance of Sickle Cell Centers (NASCC) on the essential health data elements for a standardized EHR Transition Note. Templates were created in 2 different EHR systems and piloted at 2 SCD centers. Perceived clinician acceptability, appropriateness, and feasibility were assessed using the AIM-IAM-FAM measures …

The Mycancergene Study: A Hybrid Type 1 Effectiveness-Implementation Randomized Study Comparing A Patient-Centered Digital Genetic Health Portal To Usual Care After Receipt Of Cancer Genetic Testing, Daniel Chavez-Yenter, Dominique Fetzer, Brian Egleston, Susan Domchek, Linda Fleisher, Lynne Wagner, Kuang-Yi Wen, Kelsey Karpink, Lauren Gutstein, Shelby Posen, Enida Selmani, Briana Mcleod, Arravinth Anantharajah, Sarah Brown, Cara Cacioppo, Jacqueline Cappadocia, Jessica Ebrahimzadeh, Dana Falcone, Sarah Howe, Claire Langer, Beth Mccarthy-Wood, Michelle Weinberg, Angela Bradbury

Department of Medical Oncology Faculty Papers

BACKGROUND: Genetic testing has become more complex with the transition from single gene testing to multi-gene panels and whole-exome sequencing. The adoption of more complex genetic testing and the promise of precision medicine has created a critical and urgent need for longitudinal clinical follow-up with patients who undergo cancer genetic testing given the residual uncertainty. There is an increasing need for multidisciplinary translational research that focuses on how to advance precision medicine discoveries into clinical practice and to capitalize on connectivity (e.g. digital health) interventions in ways that optimize cancer risk reducing behaviors in real-world clinical populations.

METHODS: The overall …

Perfusion Assessment In Ceus Imaging For Estimating Pancreatic Cancer Response To Sonoporation-Enhanced Chemotherapy., Omri Adler, Priscilla Machado, Trang Vu, Flemming Forsberg, Odd Helge Gilja, Dan Adam

Department of Radiology Faculty Papers

Accurate assessment of perfusion in vital organs like the pancreas is crucial for monitoring various pathologies, particularly tumors and their growth. While tumor growth inhibition usually results in decreased vascularization, current techniques for non-invasive and cost-effective perfusion assessment lack sufficient vessel separability for pancreatic applications, hindering optimal treatment selection and monitoring. Ultrasound (US) imaging offers advantages like low cost, rapid acquisition, non-invasiveness, and non-ionizing radiation. However, speckle, patient-related and acquisition-related motion artifacts, and limitations in distinguishing contrast-enhanced blood vessels, particularly in single frames, pose significant challenges. This study presents a novel solution utilizing image analysis of US contrast agents (UCAs) …

Distinct Spatiotemporal Patterns Of White Matter Hyperintensity Progression, Jinyong Chung, Gilsoon Park, Wi-Sun Ryu, Dawid Schellingerhout, Hang-Rai Kim, Dong-Seok Gwak, Elizabeth Haddad, Neda Jahanshad, Beom Joon Kim, Keun-Sik Hong, Hyerin Oh, Sang-Wuk Jeong, Joon-Tae Kim, Man Seok Park, Kang-Ho Choi, Kyungbok Lee, Tai Hwan Park, Sang-Soon Park, Jong-Moo Park, Kyusik Kang, Kyung-Ho Yu, Mi Sun Oh, Soo Joo Lee, Jae Guk Kim, Jae-Kwan Cha, Dae-Hyun Kim, Jun Lee, Moon-Ku Han, Yong-Jin Cho, Byung-Chul Lee, Philip M Bath, Joanna M Wardlaw, Hee-Joon Bae, Hosung Kim, Dong-Eog Kim

Faculty, Staff and Student Publications

White matter hyperintensity, a key imaging biomarker for brain health, has prognostic implications for stroke. Using a multicenter MRI dataset of 9179 stroke patients plus the UK Biobank (n = 36,210 low/high risk controls), we employ Subtype and Stage Inference modeling and identify three distinct white matter hyperintensity progression subtypes: fronto-parietal, radial, and temporo-occipital. Longitudinal validation confirms classification stability. The fronto-parietal subtype shows delayed onset and more hypertension, while the temporo-occipital subtype has more atrial fibrillation and coronary heart disease. The fronto-parietal and radial subtypes are linked to small vessel stroke, while the temporo-occipital subtype is linked to cardioembolism. The …

Lorbin: Efficient Binning Of Long-Read Metagenomes By Multiscale Adaptive Clustering And Evaluation, Wei Xue, Zuo Liu, Yaozhong Zhang, Waseem Raza, Yarong Li, Li Jiang, Ye Tao, Jun Qian, Jousset Alexandre, Fang-Jie Zhao, Yangchun Xu, Fritz Sedlazeck, Qirong Shen, Gaofei Jiang, Zhong Wei

Faculty, Staff and Students Publications

Long-read sequencing has transformed metagenomics and improved the quality of metagenome-assembled genomes (MAGs). However, current binning methods struggle with identifying unknown species and managing imbalanced species distributions. Here, we present LorBin, an unsupervised binner specially designed to reconstruct MAGs in natural microbiomes. LorBin deploys a two-stage multiscale adaptive DBSCAN and BIRCH clustering with evaluation decision models using single-copy genes to maximize MAG recovery. LorBin outperforms six competing binners in both simulated and real microbiomes, including oral, gut, and marine samples. LorBin generated 15-189% more high-quality MAGs with high serendipity and identified 2.4-17 times more novel taxa than state-of-the-art binning methods. …

Tetanus And Diphtheria Vaccination Coverage And Electronic Health Record Alerts For Immigrants And Refugees At Three United States Health Systems, 2017-2023, Abigail Steiner, Ann Settgast, Malini Desilva, Colleen Payton, Kristine Knuti Rodrigues, Margaret Nolan, Ella Chrenka, Mateo Frumholtz, Jeremy J Michel, Amy Stein, Blain Mamo, Janine Young

Department of Medicine Faculty Papers

Tetanus and diphtheria (tetanus/diphtheria) infections are rare in the United States (U.S.), but adequate vaccination is essential to prevent disease and associated morbidity and mortality. Compared with U.S.-born persons, immigrant and refugee adults have lower completion rates for tetanus/diphtheria vaccination series. However, most electronic health record (EHR)-generated recommendations only advise tetanus/diphtheria vaccines every 10 years for persons ≥18 years. This analysis compared documented completion of tetanus/diphtheria 3-dose vaccination series with EHR-generated recommendations for immigrant and refugee patients at three U.S. health systems seen during 2017-2022. The EHR documented complete 3-dose tetanus/diphtheria vaccine series for 28 % of 50,829 adult immigrant …

Enhancing Cyberattack Resiliency Through The Radiotherapy Backup And Recovery Dashboard Tool, Justin Pijanowski, Eric Nguyen, Yasin Abdulkadir, Justin Hink, Yevgeniy Vinogradskiy, James Lamb

Department of Radiation Oncology Faculty Papers

PURPOSE: Radiation Oncology departments impacted by recent cyberattacks were unable to access data backups or their Record and Verify (R&V) system and therefore faced challenges to resume patient treatments in a timely manner. We present a novel software tool that backs-up critical radiotherapy treatment information and displays essential information for on-treatment patients in an intuitive and accessible dashboard allowing clinics to continue radiotherapy treatments. The purpose of this report is to describe implementation details, challenges, and share open-source code to facilitate radiation oncology clinics' efforts to develop tools to improve cyberattack resiliency.

METHODS: The Radiotherapy Backup and Recovery Dashboard Tool …

Association Between End-Of-Third-Year Objective Structured Clinical Examinations And Accreditation Council For Graduate Medical Education Milestones During Intern Year, Katherine Berg, Jillian Zavodnick, Dianna Cheney-Peters, Heather Heiman, Sally Santen, Yoon Soo Park, Anita Wilson

Department of Medicine Faculty Papers

BACKGROUND: The Objective Structured Clinical Examinations (OSCEs) administered in medical schools have increased in importance with the elimination of United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills (CS).

OBJECTIVE: The purpose of this study was to understand the association between student performance on an end-of-third-year OSCE and performance in residency.

METHODS: This study explored the correlations between OSCE performance and relevant Accreditation Council for Graduate Medical Education (ACGME) milestone 1.0 performance. This study included students’ scores from 139 Sidney Kimmel Medical College (SKMC) students who completed an end-of-third-year OSCE during 2015 and 2016 and completed an intern year …

Genome-Wide Association Study Of Childhood B-Cell Acute Lymphoblastic Leukemia Reveals Novel African Ancestry-Specific Susceptibility Loci, Cindy Im, Andrew R Raduski, Lauren J Mills, Kashi Raj Bhattarai, Robert J Mobley, Kelly R Barnett, Zhanni Lu, Kenneth Liao, Nathan Anderson, Rebecca A Johnson, Erica Langer, Anthony J Hooten, Alix E Seif, Kathrin M Bernt, Matthew Tsang, Brandon A Mamou, Luis Gil-De-Gómez, Julie A Wolfson, Danielle N Friedman, Neerav Shukla, Laura J Klesse, Erin L Marcotte, Lingyun Ji, Alice Dang, Minjie Luo, Yiming Zhong, Jalen Langie, Charleston W K Chiang, Adam De Smith, Joseph L Wiemels, Andrew Dewan, Xiaomei Ma, Catherine Metayer, Zhaoming Wang, Heather H Nelson, Nathan Pankratz, Tianzhong Yang, Saonli Basu, Lucie M Turcotte, Jun J Yang, Daniel Savic, Michael E Scheurer, Logan G Spector

Faculty, Staff and Students Publications

B-cell acute lymphoblastic leukemia (B-ALL) is the most common pediatric malignancy. Given racial/ethnic differences in incidence and outcomes, B-ALL genome-wide association studies among children of African ancestry are needed. Leveraging multi-institutional datasets with 840 African American children with B-ALL and 3360 controls, nine loci achieved genome-wide significance (P <  5 × 10−8) after meta-analysis. Two loci were established trans-ancestral susceptibility regions (IKZF1, ARID5B), while the remaining novel loci were specific to African populations. Five-year overall survival among children carrying novel risk alleles was significantly worse (83% versus 96% in non-carriers, P = 4.8 × 10−3). Novel risk variants were also associated with subtype-specific disease (P <  0.05), including higher susceptibility for a subtype overrepresented in African American children (TCF3-PBX1) and lower …

Defining Endotypes Of Bronchopulmonary Dysplasia In Preterm Infants To Improve Precision-Based Therapies., Megha Sharma, Gangaram Akangire, Noah H. Hillman, Winston M. Manimtim, Mark Ivan Attard, Venkatesh Sampath

Manuscripts, Articles, Book Chapters and Other Papers

Bronchopulmonary dysplasia (BPD) remains a debilitating disease in premature infants. The chronic pathogenesis of BPD with complex prenatal and postnatal programming challenges attempts at precisely defining or treating disease. While existing BPD definitions categorize disease severity, a lack of consideration of disease heterogeneity and endotypes has contributed to the failure of clinical trials to improve BPD outcomes. Recent studies have used advanced lung imaging techniques, echocardiography, and lung function tests to identify airway, parenchymal, and vascular BPD endotypes. These endotypes carry different prognoses and require endotype-specific treatment strategies to optimize infant outcomes. In this Review, we focus on the pathogenic …

Apoa1 Binding Protein Promotes Lymphatic Cell Fate And Lymphangiogenesis By Relieving Caveolae-Mediated Inhibition Of Vegfr3 Signaling, Jun-Dae Kim, Surbhi Chaudhary, Weiqing Chen, Jonathan Astin, Philip S Crosier, Pengchun Yu, John P Cooke, Henry J Pownall, Hugo J Bellen, Nhat-Tu Le, Daniel L Kiss, Guangyu Wang, Stanley G Rockson, Hong Chen, Longhou Fang

Faculty, Staff and Students Publications

The lymphatic system maintains tissue fluid balance, and its dysfunction can result in lymphedema. Although cholesterol is essential for cellular function, its role in lymphatic development has remained unknown. Here, we identify APOA1 binding protein (AIBP) as a key regulator that promotes lymphatic endothelial cell fate specification and lymphangiogenesis. Mechanistically, AIBP reduces plasma membrane cholesterol content, thereby enhancing VEGFR3 signaling by disrupting caveolae—small plasma membrane invaginations formed by the scaffolding protein caveolin-1 (CAV-1)—and relieving CAV-1–mediated inhibition. In zebrafish and mice, AIBP loss impairs VEGFR3 signaling and lymphatic development, defects that can be rescued by CAV-1 deletion or by a VEGFR3 …

Emergency Department-Initiated Palliative Care Screening Among Older Adults: A Systematic Review And Meta-Analysis Protocol, Dimitri E Lin, Satheesh Gunaga, Fabrice I Mowbray, Eric D Isaacs, Daniel Markwalter, Naomi George, Alison E Hay, Rita Manfredi, Erica Westlake, Murtaza Akhter, Jason K Bowman, Naomi Rebollo-Lee, Brian Gacioch, Alexander D Ginsburg, Justin Kenneth Brooten, Sarah Pajka, Katie Selman, Paul Bain, Joshua J Davis, Shan Liu, Kei Ouchi

Faculty, Staff and Students Publications

Introduction: The rapidly growing population of older adults (individuals aged 65 years and older) presents a new set of challenges for healthcare providers in the emergency department (ED), given the prevalence of severe and life-threatening conditions among this group, such as chronic cancer, Alzheimer's disease/dementia and congestive heart failure. ED encounters often represent a critical point in an older patient's trajectory of care and can thus be an important opportunity for various interventions such as palliative care consultation. Therefore, identifying those who will benefit most from palliative care is of high importance, especially in determining the course of future treatment. …

A Hybrid Model For Youth Engagement In Adolescent Health Studies: Insights From The Teen Research Advisors Program At A Midwestern Pediatric Academic Medical Center In The United States., John Tumberger, Alaina N. Burns, Michael Bartkoski, Mariah E. Brewe, Amelia Whittier, Kendyll Gethers, Ailisi Bogdon, Emerie Peterson, Stephani L. Stancil

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Engaging adolescents in research ensures studies are relevant, ethical, and beneficial while fostering authentic and applicable findings. Traditional in-person advisory boards face barriers to equitable participation, highlighting the need for innovative, flexible models tailored to specific research programs and individuals with lived experience. The primary aim of this article is to describe a novel hybrid youth advisory board suitable for informing ongoing operations of a research program while supporting youths' education and career exploration. Our secondary aim was to evaluate initial impact over the first 2 years of the program (2023-2024).

METHODS: Adolescents aged 12-21 with prior involvement in …

Influences On Emergency Clinician Use Of Health Information Exchange: Interview Study, Brian E. Dixon, Umesh Ghimire, Benjamin Richter, Corinne Bowditch, Saurabh Rahurkar, John T. Finnell, Joshua R. Vest

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Health information exchange (HIE) supports clinical decision-making in emergency medicine settings. Despite evidence and policies that encourage the adoption of HIE, use by clinicians is limited. Moreover, few studies examine HIE use years after adoption by hospitals or clinics.

OBJECTIVE: This study aims to examine the perceptions and use of a mature, operational HIE system by emergency department clinicians years after its implementation.

METHODS: We interviewed 21 clinicians in various roles (eg, attending physician and nurse practitioner) across multiple health systems that participate in a statewide HIE network. We asked questions about their use of the HIE system and …

Global Burden Of 292 Causes Of Death In 204 Countries And Territories And 660 Subnational Locations, 1990–2023: A Systematic Analysis For The Global Burden Of Disease Study 2023, Gbd 2023 Causes Of Death Collaborators

Faculty, Staff and Students Publications

Background: Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of …

Visualization Of Lysosomal Membrane Proteins By Cryo Electron Tomography, Bridget M Mcveigh, José J De Jesús-Pérez, Dirk H Siepe, Prerana Gogoi, Shrawan Kumar Mageswaran, Marian Kalocsay, Elaine M Mihelc, Vera Y Moiseenkova-Bell

Faculty, Staff and Student Publications

Lysosomes are essential organelles for cellular homeostasis and signaling, with dysfunction linked to neurological disorders, lysosomal storage diseases, and cancer. While proteomics has advanced our understanding of lysosomal composition, the structural characterization of lysosomal membrane proteins in their native environment remains a significant challenge. Here, we developed a cryo electron tomography workflow to visualize lysosomal membrane proteins within intact, native lysosomal membranes. We isolated endolysosomes by independently targeting two lysosomal membrane proteins, transient receptor potential mucolipin 1 and transmembrane protein 192, enriching organelles that exhibited the expected morphology and proteomic composition of the endolysosomal system. Sub-tomogram averaging enabled the structural …

Interventions To Minimize Unnecessary Antibiotic Use For Acute Otitis Media: A Meta-Analysis., Theresa L. Morin, Amy B. Stein, Rana El Feghaly, Amanda Nedved, Sophie E. Katz, Amy Keith, Heather E. Laferriere, Timothy C. Jenkins, Holly M. Frost

Manuscripts, Articles, Book Chapters and Other Papers

Backgrounds/Objectives: Acute otitis media (AOM) is the leading reason antibiotics are prescribed to children. Despite guidelines advocating for watchful waiting and shorter antibiotic durations, overprescribing remains a concern. This meta-analysis aims to quantify potential reduction in antibiotic days of therapy (DOT) for AOM if prescribers adhered to guidelines. Methods: Cochrane databases were sourced for studies on ear infections, diagnostic accuracy, antibiotic duration, and watchful waiting. Randomized clinical trials, observational studies, and quality improvement reports of children aged 6 months-17 years with uncomplicated AOM published between 2000 and 2024 from the U.S., Canada, and Europe. Of 4187 studies, 425 met selection …

Screentime And Effects On Pediatric Mental Health, Bob Underwood, Libby Milkovich

Pediatrics in Practice: A CME Podcast

Dive into the world of pediatric mental health as Dr. Libby Milkovich discusses the concerning trends related to screen time usage in children. Discover the neurological and behavioral mechanisms at play, and learn how screen habits established in early childhood can impact emotional well-being as kids grow.

Click here to stream the podcast episode.

Utility And Safety Of Artificial Intelligence For Patient-Initiated Contact After Functional Rhinoplasty, W. Jack Palmer, Dana Michlin, Leonard Estephan, Jason Tasoulas, Khashayar Arianpour, Harleen K. Sethi, Daniel J. Campbell, Howard Krein, Ryan Heffelfinger

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To understand the content of patient calls after functional rhinoplasty and to evaluate artificial intelligence chatbots' ability to provide accurate, intelligible, and safe responses.

STUDY DESIGN: Retrospective review.

SETTING: Tertiary-care institution.

METHODS: A single-institution, retrospective review was conducted for patients who underwent functional rhinoplasty between 2017 to 2023. Postoperative calls and messages prior to first follow-up were analyzed, and 48 representative prompts were generated, including 6 "Red Flag Questions" indicating potential complications. Prompts were input into 4 chatbots (ChatGPT, Claude, Perplexity, and Gemini). Two independent, blinded experts graded responses using a Likert-style Global Quality Scale (GQS) and a binary …

Genetic Determinants And Genomic Consequences Of Non-Leukemogenic Somatic Point Mutations, Joshua S Weinstock, Sharjeel A Chaudhry, Maria Ioannou, Maria Viskadourou, Paula Reventun, Yasminka A Jakubek, L Alexander Liggett, Cecelia Laurie, Jai G Broome, Alyna Khan, Kent D Taylor, Xiuqing Guo, Patricia A Peyser, Eric Boerwinkle, Nathalie Chami, Eimear E Kenny, Ruth J Loos, Bruce M Psaty, Russell P Tracy, Jennifer A Brody, Jeong H Yun, Michael H Cho, Ramachandran S Vasan, Sharon L Kardia, Jennifer A Smith, Laura M Raffield, Aurelian Bidulescu, Emily C O'Brien, Mariza De Andrade, Jerome I Rotter, Stephen S Rich, Russell P Tracy, Yii Der Ida Chen, C Charles Gu, Chao A Hsiung, Charles Kooperberg, Bernhard Haring, Rami Nassir, Rasika Mathias, Alex Reiner, Vijay G Sankaran, Charles J Lowenstein, Thomas W Blackwell, Goncalo R Abecasis, Albert V Smith, Hyun M Kang, Pradeep Natarajan, Siddhartha Jaiswal, Alexander Bick, Wendy S Post, Paul Scheet, Paul Auer, Theodoros Karantanos, Alexis Battle, Marios Arvanitis

Faculty, Staff and Students Publications

Clonal hematopoiesis (CH) is defined by the expansion of a lineage of genetically identical cells in blood. Genetic lesions that confer a fitness advantage, such as leukemogenic point mutations or mosaic chromosomal alterations (mCAs), are frequent mediators of CH. However, recent analyses of both single cell-derived colonies of hematopoietic cells and population sequencing cohorts have revealed CH frequently occurs in the absence of known driver genetic lesions. To characterize CH without known driver genetic lesions, we use 51,399 deeply sequenced whole genomes from the NHLBI TOPMed sequencing initiative to perform simultaneous germline and somatic mutation analyses among individuals without leukemogenic …