Digital Commons Network^™

Leading Healthcare Improvement: An Implementation Strategy, Kelley Arredondo, Anthony Ecker, Lindsay Vaclavik, Jacquelene Shahin, Ashley Thompson, Molly Horstman, David Ramsey, Kyler M Godwin

Faculty, Staff and Students Publications

Introduction: Healthcare professionals often implement quality improvement (QI) initiatives but lack training to implement and sustain QI initiatives. Leading Healthcare Improvement (LHI) is a course that combines principles from change management, team science, and leadership effectiveness into an implementation strategy to enable clinicians to lead sustainable change.

Methods: LHI is a 6-session, 4-month interactive training. Learners work on an active QI project throughout the course. A Wilcoxon signed-rank test was conducted to evaluate pre- and post-course changes in learners' self-reported confidence across five QI competencies.

Results: Veterans Healthcare Administration clinicians and fellows completed the LHI pre- (n = 111) and …

Oncocytic Intraductal Carcinoma Of The Parotid Gland With Strn::Alk Fusion, Reham H Soliman, Chris Shi, Kevin E Fisher, Hong Yu, Fouad El-Dana, Xu Cao, Li Liang, Pei Ying, Songlin Zhang

Faculty, Staff and Students Publications

Intraductal carcinoma (IDC) of the salivary gland is an uncommon epithelial neoplasm characterized by a predominantly intraductal or intracystic proliferation rimmed by a myoepithelial cell layer. Advances in molecular profiling have revealed recurrent gene fusions in IDC, most frequently involving RET, although fusions implicating other kinase genes have also been described. Among these, ALK rearrangements are rare and remain poorly characterized. Herein, we report a case of oncocytic IDC of the parotid gland harboring a STRN::ALK fusion, further expanding the molecular landscape of this tumor. Although this fusion has been previously reported in intercalated duct IDC, to our knowledge, this …

Cervical Insufficiency Revisited: A Proposal For A New Treatment-Aligned Definition, Vincenzo Berghella, Ilaria Paladino, Moti Gulersen, Rupsa Boelig, Amanda Roman

Department of Obstetrics and Gynecology Faculty Papers

Cervical insufficiency [CI] has traditionally been defined as painless cervical dilation resulting in recurrent second-trimester pregnancy loss in the absence of labor or placental pathology. Definitions from the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists emphasize historical clinical presentation. However, contemporary obstetrics relies increasingly on ultrasound-based cervical length surveillance and evidence-based cerclage indications rather than retrospective diagnosis. The objective of the review was to propose a definition of cervical insufficiency aligned with current evidence-based indications for mechanical prevention of preterm birth, i.e. cervical cerclage. In modern obstetric practice, the operational diagnosis of clinically …

Dnp Final Report: Enhancing Radiation Oncology Training For Advanced Practice Providers, Katherine A. Bukolt

DNP Final Reports

Background: Rising cancer incidence and improved survivorship are straining the oncology workforce, increasing reliance on Advanced Practice Providers (APPs). However, there is a lack of standardized educational resources for APP radiation oncology training across practice settings. Most APPs receive variable, resource-dependent, and on-the-job training. Evidence shows that the lack of standardized training leads to gaps in foundational knowledge, reduced confidence in toxicity management, inconsistent role development, and variable satisfaction with training and transition into practice.

Purpose: This quality improvement project evaluated the feasibility of implementing an 18-module Advanced Practice Radiation Oncology (APRO) asynchronous online curriculum to standardize APP radiation oncology …

Association Of Cerebrovascular Center Volume With Patient Outcomes, Stacey Quintero Wolfe, Justin R. Mascitelli, Kyle Fargen, Peter Kan, Ketan Bulsara, Christopher P. Kellner, Brian M. Howard, Michael R. Levitt, Rocco Armonda, Joshua Osbun, Clemens Schirmer, Mark Bain, William J. Mack, Stavropoula Tjoumakaris, Adam Arthur

Department of Neurosurgery Faculty Papers

Current guidelines acknowledge the importance of both microsurgical and neuroendovascular expertise in the treatment of cerebrovascular disease. To achieve optimal care for these patients, it is becoming increasingly evident that procedural volumes impact patient outcomes. This is demonstrated across various cerebrovascular diseases.In this literature review, we demonstrate the association of volume with patient outcomes across multiple cerebrovascular disease states and interventions. Microsurgical aneurysm clipping remains essential even with the rise of endovascular therapy and mortality and patient-safety indicator events are clearly lower at high-volume centers for both ruptured and unruptured aneurysms. Likewise, patients undergoing surgery for cerebrovascular malformations and carotid …

Reply To: A Lethal Progressive Neuroinflammation Disguised As Mogad Revealing A Final Diagnosis Of Griscelli Syndrome: Regarding: Mogad Is The Most Common Cause Of Isolated Optic Neuritis In Children, Chaitanya Aduru, Akansha Chandrasekar, Kyla Blasingame, Jonathan Rosen, Jesse M Levine, Karla Salazar, Madhuri Chilakapati, Rod Foroozan, Victoria Adeseye, Jonathan M Yarimi, Nikita Shukla, Timothy E Lotze, Kristen S Fisher, Alexander J Sandweiss

Faculty, Staff and Students Publications

No abstract provided.

Chemotherapeutic Induction Of Cytosolic Single-Stranded Dna Accumulation Sensitizes Triple-Negative Breast Cancer To Immunotherapy, Yong Du, Li Yang, Hui Dai, Jianli Zhou, Zhicheng Zhou, Ruoxi Yuan, Rui Ye, Anh Thai Quynh Nguyen, Kishor Bhatia, Shiaw-Yih Lin

Faculty, Staff and Students Publications

Background: Despite the widespread adoption of chemoimmunotherapy in triple-negative breast cancer (TNBC), the mechanisms by which cytotoxic chemotherapy engages antitumor immunity remain poorly defined. Identifying tumor-intrinsic immunogenic programs that predict and enhance responsiveness to immune checkpoint blockade (ICB) is therefore of critical clinical importance.

Methods: Transcriptomic signatures of TREX1 deficiency were generated from CRISPR-engineered TNBC models and applied to multiple independent TNBC cohorts treated with chemoimmunotherapy. Cytosolic single-stranded DNA (ssDNA) accumulation was quantified using a flow cytometry-based assay to functionally screen chemotherapeutic agents. Immune activation and therapeutic efficacy were evaluated using in vitro assays, syngeneic mouse tumor models, flow cytometry, …

Unveiling Unwritten Curricula: Enhancing Junior Faculty Development In Academic Emergency Medicine, Abagayle Bierowski, Casey Morrone, Erin Hoag, Ridhima Ghei, Michael Pasirstein, Julie Blaszczak, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

INTRODUCTION: The transition from resident to junior faculty in academic emergency medicine (EM) may be shaped not only by formal training and institutional policies but also by the "unwritten curriculum," a set of norms and expectations embedded in institutional culture. However, the unwritten curriculum and its potential to impact junior faculty development remains largely unexplored. Little is known about how junior faculty perceive, experience, and navigate these informal expectations, or the formal and informal structures that influence this process. In this study we aimed to explore junior faculty members' experiences with the unwritten curriculum in academic EM, with a focus …

Letter To The Editor: Hemodynamic Role In Hepatic Encephalopathy Pathogenesis Following Transjugular Intrahepatic Portosystemic Shunt Placement, John Halphen, Yash S Dayal, Cameron Laurie, Mohadese Ahmadzade, David Wynne, Mohammad Ghasemi-Rad

Faculty, Staff and Students Publications

Hepatic encephalopathy (HE) is a common complication following transjugular intrahepatic portosystemic shunt (TIPS) placement and is thought to result from reduced hepatic detoxification of neurotoxins. However, Zhuang et al in the World Journal of Radiology demonstrate that this understanding may be incomplete through exploration of the pathophysiology from a hemodynamic perspective. They found significant changes in cerebral blood flow (CBF) and spontaneous brain activity following TIPS. Initially, CBF increased in specific areas within the first month, followed by a return to baseline at three months. These CBF changes coincided with increased spontaneous brain activity that persisted in some areas, suggesting …

Postpartum Spontaneous Coronary Artery Dissection Complicated By Ventricular Fibrillation: A Case Report, Han Wei Zheng, Ariana Rucker, Kelsey Van Housen, Patrick Faherty

Department of Emergency Medicine Faculty Papers

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognized cause of acute coronary syndrome (ACS), particularly in young women without traditional cardiovascular risk factors. Although SCAD frequently presents as myocardial infarction, life-threatening arrhythmic complications such as cardiac arrest remain rare and may complicate timely diagnosis and management. Pregnancy-associated SCAD is associated with increased clinical severity and a higher risk of complications. This case is notable for the occurrence of ventricular fibrillation arrest, as well as the coexistence of SCAD with features of stress-induced cardiomyopathy.

CASE PRESENTATION: A 33-year-old African American female, 9 days postpartum following an uncomplicated …

Long-Term Functional Synaptic Integration Of Genome-Edited Retinal Organoids In A Primate Model Of Macular Degeneration, Atsuta Ozaki, Akihiro Kawai, Ryutaro Akiba, Satoko Okayama, Nobuhiko Ohno, Keisuke Kajita, Tomohiro Masuda, Satoshi Yokota, Shin-Ichiro Ito, Du Peiyan, Kenta Onoue, Shigenobu Yonemura, Mineo Kondo, Yasuo Kurimoto, Yingbin Fu, Michiko Mandai

Faculty, Staff and Students Publications

Retinal organoids represent a promising regenerative strategy for restoring vision in retinal degenerative diseases, but the capacity of host cone bipolar cells in the primate macula to rewire with transplanted photoreceptors has not been established. In this study, we transplanted genome-edited ISL1-/- human retinal organoids lacking ON-bipolar cells into an acute laser-induced macular photoreceptor ablation non-human primate model. Using immunohistochemistry, ultrastructural imaging, and focal macular electroretinography, we demonstrate that host rod and cone bipolar cells actively extend dendrites toward grafted photoreceptors and form synaptic contacts, with evidence of functional signal transmission in a subset of transplanted eyes. Longitudinal, per-eye analyses …

Syphilis And Hiv Co-Infection Risk Factors At Dr. Moewardi Hospital, 2018–2022: A Retrospective Study, Endra Yustin Ellistasari, Prasetyadi Mawardi, Pratiwi Prasetya Primisawitri, Stella Gracia Octarica

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Treponema pallidum, the agent causing syphilis, is transmitted through contact with infectious lesions, bodily fluids, blood transfusions, or perinatally. Human immunodeficiency virus (HIV) infection can mask the clinical manifestations of syphilis, while syphilis may exacerbate HIV progression. This study aimed to analyze risk factors associated with HIV co-infection among patients with syphilis.

Methods: This retrospective, analytical, observational study reviewed medical records from the Dermatology and Venereology outpatient clinic at Dr. Moewardi Hospital, Surakarta, Indonesia, between January 2018 and December 2022. Demographic, behavioral, and clinical variables were extracted. Univariable analysis was performed using simple binary logistic regression to …

Prognosis Of Early-Onset Alopecia Areata: An Evidence-Based Case Report, Sarah Qanita Edwar, Lili Legiawati, Stefani Reditya Anggraini, Ratu Siti Khadijah Sarah

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Alopecia areata (AA) is an autoimmune, non-scarring hair loss disorder commonly affecting children and often characterized by a chronic or relapsing course. Early-onset AA has traditionally been associated with a poorer prognosis, although current evidence remains inconclusive. This evidence-based case report aims to evaluate the prognostic significance of early-onset AA by synthesizing available cohort data.

Methods: A structured literature search was conducted in PubMed, EMBASE, Scopus, ProQuest, and Cochrane databases using a population, intervention, comparison, and outcome framework. Keywords included “alopecia areata”, “child”, “pediatrics”, “early-onset”, “recurrence”, and “prognosis”.

Results: Five retrospective cohort studies (n = 760) were included. …

Exploring Pediatric Leprosy In An Endemic Area: Case Series Of Eight Patients In Indonesia, Gitalisa Andayani Adriono, Tri Rahayu, Sri Linuwih Sw Menaldi, Nelfidayani Nelfidayani, Retno Sulistyo Wardani, Kahlil Gibran, Malika Sabrina Yunifananda, Kartika Qonita Putri, Yunia Irawati

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Leprosy remains a significant public health concern in endemic regions such as Indonesia. Children are particularly vulnerable due to their naive immunity and close familial contacts. This study aims to report cases of pediatric leprosy in Lembata, Indonesia, focusing on clinical characteristics and associated risk factors.

Case Illustration: A case series of eight pediatric patients (<15 >years) diagnosed with leprosy was conducted during a community-based screening program in Lembata, Indonesia, in 2022. Of 140 individuals examined, 8 were children. Most patients were male (6/8) with a mean age of 11.75 years. Multibacillary (MB) leprosy predominated (7/8), and a history …

Folr1-Targeted Actinium-225-Based Alpha-Particle Therapy Eliminates Ovarian Cancer, Neetu Singh, Esther Need, Ayden Berndt, Matthew Goff, Lydia J. Wilson, Firas Mourtada, Feng Guo, Tara Mastren, Taslim Al-Hilal, Anil K. Sood, Amit Maity, Scott C. Miller, Satoshi Minoshima, Shreya Goel, Sixiang Shi

Department of Radiation Oncology Faculty Papers

Despite the advancement in therapies, ovarian cancer treatment is challenging because of poor prognosis and high relapse associated with acquired resistance. Emerging targeted alpha particles, particularly actinium-225 (225Ac), for treating refractory cancers have opened avenues for improved therapeutic options. Here, we describe a successful example of folate receptor 1 (FOLR1)–targeted 225Ac alpha-particle therapy for treatment of ovarian cancer. Longitudinal positron emission tomography imaging demonstrated high tumor-specific uptake of αFOLR1 (anti-FOLR1 antibody) in SKOV3 xenografts. FOLR1-targeted 225Ac demonstrated high therapeutic efficacy, achieving marked tumor regression, 80% survival, and 40% complete tumor elimination. The therapy resulted in tumor-specific double-stranded DNA damage, and …

Plasma Gdf15 Affects Long-Term Dementia Risk And Alters Neuroimmune Signaling, Cassandra O Blew, Michael R Duggan, Dimitrios Tsitsipatis, Gabriela T Gomez, Zulema Rodriguez-Hernandez, Luke C Pilling, Jingsha Chen, Eva Jacobsen, Heather E Dark, Yifei Lu, Shannon M Drouin, Cassandra M Joynes, Minhao Yao, Murat Bilgel, Abhay Moghekar, Qu Tian, Julián Candia, Mary Kaileh, Aditi Gupta, Krystyna Mazan-Mamczarz, Myriam Gorospe, Alexey Lyashkov, Yevgeniya Lukyanenko, Mika Kivimaki, Philipp Frank, Lori L Jennings, Valborg Gudmundsdottir, Vilmundur Gudnason, Lenore J Launer, Naoto Kaneko, Shintaro Kato, Makio Furuichi, Masaki Shibayama, Masahisa Katsuno, Keita Hiraga, Yukiko Nishita, Rei Otsuka, James R Pike, Mary R Rooney, Pascal Schlosser, Yuhan Cui, Guray Erus, Christos Davatzikos, Rebecca F Gottesman, Iwao Waga, Priya Palta, Christie Ballantyne, Michael Griswold, Zhonghua Liu, Luigi Ferrucci, Allison B Herman, Keenan A Walker

Faculty, Staff and Students Publications

Growth/differentiation factor-15 (GDF15) is a secreted cytokine strongly associated with dementia risk. However, the extent to which GDF15 represents a biomarker and driver of dementia risk remains unclear. Across multiple cohorts, we demonstrated that plasma GDF15 is associated with greater dementia risk over 15- to 25-year follow-up periods when measured in midlife, with stronger associations observed for vascular, compared to Alzheimer's disease (AD), dementia. Two-sample Mendelian randomization supported plasma GDF15's mechanistic role in AD and related dementias, while cohort studies linked it to cerebral small vessel disease, neurodegeneration, phosphorylated tau, and a cerebrospinal fluid proteomic signature indicative of neuroimmune activation. …

Objectively And Subjectively Measured Physical Activity Levels Among Children And Adolescents In Poland (2012–2022): A Systematic Review, Jarosław Herbert, Vasylyna Petrovets

Baltic Journal of Health and Physical Activity

This article aims to provide a comprehensive review of research on physical activity levels among children and adolescents in Poland from 2012 to 2022, considering both objective and subjective assessment methods. A systematic review of the literature was conducted in accordance with the PRISMA reporting recommendations. PubMed, Scopus, Web of Science, Google Scholar databases, as well as Polish scientific databases were searched. The review included studies published from 2012 to 2022, on children and adolescents aged 3–18 living in Poland, assessing physical activity levels using objective and/or subjective methods. This analysis of the selected studies showed that physical activity levels …

Adaptation Of The Transition Readiness Assessment Questionnaire For Pediatric-Onset Multiple Sclerosis: Protocol For A User-Centered Design Approach, Claudia Gambrah-Lyles, Aaron W Abrams, Sara Loud, Hollie Schmidt, Emily Blosberg, Melissa Wright, Kelsey E Poisson, Kristen S Fisher, Kimberly A O'Neill, Akash Virupakshaiah, John W Rose

Faculty, Staff and Students Publications

Background: Pediatric-onset multiple sclerosis (POMS) is a chronic, progressive neurologic condition requiring lifelong management and coordinated transition from pediatric to adult care. Evidence-based guidelines identify transition readiness assessment as a core component of successful transition; however, most POMS clinics do not formally assess readiness, and existing tools do not address POMS-specific challenges, such as fluctuating disability, complex treatment regimens, and cognitive impairment. This gap underscores the need for a transition readiness measure tailored to POMS.

Objective: This paper aims to describe a stakeholder-engaged, implementation science-guided protocol for adapting the Transition Readiness Assessment Questionnaire (TRAQ) version 6.0 to reflect the unique …

From Fly On The Wall To Future Colleagues: Best Practice Recommendations For Medical Student Shadowing Programs, Molly Estes, Danielle Matonis, Mckenna Knych, Brian Barbas, Ronnie Ren, William Dixon, Michael Pasirstein, Xiao C. Zhang, Kaitlin Bowers, Ravi R. Chauhan, Laryssa A. Patti

Department of Emergency Medicine Faculty Papers

BACKGROUND: Physician shadowing is a common component of early medical education and frequently represents students' first exposure to clinical practice. Despite its prevalence, existing guidance primarily targets learners rather than physicians supervising shadowing experiences. This gap is especially relevant in the emergency department (ED), where high patient acuity, workflow demands, and complex clinical environments create challenges for providing safe and meaningful observational learning. We sought to develop consensus-based best practice recommendations for ED faculty supervising medical student shadowing.

METHODS: We conducted a modified Delphi study using an online survey platform to achieve panelist consensus. Ten emergency medicine educators with a …

Intersection Of Pediatric Hypertension And Cardiovascular-Kidney-Metabolic Disease, Jessica O'Keeffe, Christina Kingshill, Jack Tompson, Andrew M. South, Carissa M. Baker-Smith

Department of Medicine Faculty Papers

PURPOSE OF REVIEW: The purpose of this review is to describe the intersection between pediatric hypertension and advancing stages of cardiovascular, kidney metabolic syndrome in children and adolescents.

RECENT FINDINGS: Cardiovascular-kidney-metabolic syndrome is highly prevalent in the pediatric population. The onset of CKM in childhood is influenced by the presence of antenatal risk factors such as maternal hypertensive disorders of pregnancy. Advancing stages of CKM in children and adolescents are strongly influenced by food insecurity and social determinants of health that impact the risk for childhood obesity. Activation of the renin-angiotensin-aldosterone system is a key mediator in the relationship between …

Meeting Report From The 2025 Cure Ocular Melanoma (Cure Om) Global Science Meeting, Amsterdam, The Netherlands, October 2025, Andrew E. Aplin, Katherina Alsina, Allison S. Betof, Joseph Birkett, Marcus O. Butler, George Cole, Rizwan Haq, Florian A. Karreth, Vinit B. Mahajan, Rahul Marpadga, Prithvi Mruthyunjaya, Paul Nathan, Jonas A. Nilsson, Gary Palmer, Joseph J. Sacco, Takami Sato, Sarah Stanhope, Pang-Ning Teng, Kyleigh Lipira

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

The 2025 Cure Ocular Melanoma (CURE OM) Global Science Meeting took place in Amsterdam, The Netherlands on October 25th, 2025. Several promising drug candidates are in development; however, there is still an urgent need for better prevention, detection, and treatment of uveal melanoma. The purpose of this meeting was to promote international collaboration and idea exchange between scientists, industry, and patient advocates.

Evaluating The Reproducibility And Verifiability Of Nutrition Research: A Case Study Of Studies Assessing The Relationship Between Potatoes And Colorectal Cancer, Yasaman Jamshidi-Naeini, Colby J Vorland, Pranav Kapoor, Bailey Ortyl, Jocelyn Mineo, Luke Still, Korlu Sorsor, Shelby Rodney, Xander Tooze, Brent Flickinger, Beate Henschel, Stephanie L Dickinson, David B Allison

Faculty, Staff and Students Publications

The credibility of nutritional research is dependent on the rigor with which studies are conducted and the ability for independent assessment to be performed. Despite the importance of these, more work is needed in the field of nutrition to buttress the trustworthiness of nutrition research. To develop and apply a process for evaluating the rigor, reproducibility, and verifiability of nutritional research, using the relationship between potato consumption and Colorectal Cancer (CRC) as a case study. We updated existing systematic reviews to include studies on potatoes and CRC, assessing their design, execution, and reporting quality. We attempted to reproduce and verify …

Self-Perceived Burden And Mental Health Outcomes In Adults With Osteogenesis Imperfecta, Emily R Strouphauer, Camille Villar, Ryan J Mccarty, Danqi Li, Gianna M Colombo, Brendan Lee, Chaya N Murali, Dianne Nguyen, Sarah Sadek, Marie-Eve Robinson, Jocelyn Gomez, Michelle Fynan, V Reid Sutton, Andrew D Wiese, Eric A Storch

Faculty, Staff and Students Publications

Osteogenesis Imperfecta (OI) is a rare disorder causing bone fragility, pain, and functional impairment that causes substantial psychosocial burden. This study examined how self-perceived burden (SPB), or distress from feelings of dependence on caregivers, relates to depression, anxiety, and suicidality in adults with OI. A total of 208 adults (M age = 42.9, predominately White and female) with OI were recruited to complete a cross-sectional survey assessing SPB, psychological symptoms, health, and sociodemographics. Results indicated that SPB was significantly higher among younger individuals, those not living with a partner, those living with adult family members, lower-income groups, and individuals …

Advocating For A Care-Based Ethic: Stories Of Pregnancy And Birth From Caregivers Of Children With Down Syndrome, Lydia Ocasio-Stoutenburg, Nayma Sultana Mim

Developmental Disabilities Network Journal

Down syndrome (DS) impacts about 1 in every 640 childbirths in the United States. While quality of life has improved for people with DS, systemic inequities and deficit-based perceptions have persisted throughout history, with material impacts on people with DS and their caregivers. Researchers have documented how caregivers of children with DS have had negative experiences with healthcare providers and genetic counselors, whose biased views about DS translate into subtle and overt pressures. Few studies explicitly focus on the experiences of Caregivers of Color, multilingual families, as well as families with varying economic experiences who have children with DS. This …

An Inf2-Dependent Actin-Mediated Step In Inositol 1,4,5-Trisphosphate Receptor Cluster Formation And Activity, Maite R. Zavala, Amrapali Ghosh, Suresh K. Joseph, Rajarshi Chakrabarti

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Intracellular calcium signaling plays a vital role in regulating various cellular processes including gene regulation, motility, metabolism, and cell death. Inositol 1,4,5-trisphosphate receptors (IP3Rs) on the endoplasmic reticulum (ER) are a major cation channel that regulates stimulus-induced calcium release from the ER. While several molecular players regulate the activity of IP3R, its regulation by actin filaments was uncharacterized. Here, we show that actin filaments polymerized by the specific actin nucleator INF2 facilitate agonist-induced IP3R activity. Our results demonstrate that INF2-mediated actin filaments regulate the formation and/or stability of IP3R clusters on the ER that have been previously shown to be …

Where Evidence-Based Medicine Meets Ai: Promise, Pitfalls, And Practice, Sangil Lee, Joshua Davis, Ken Milne, Christina Shenvi, Lars K. Beattie, Martin Wegman, Laura Melville, Richard D. Shih, Bryan Kane

Department of Emergency Medicine Faculty Papers

No abstract provided.

Integration Of Intraoperative Data In Interpretable Machine Learning Models To Predict Postoperative Aki In Noncardiac Surgery Patients, Justin Do, Karan H. Shah, Melissa Xu, Andrew Hyunwoo Kim, Vivaswat Suresh, Nidhir Guggilla, Michael Li, Rishi Kothari

Department of Anesthesiology Faculty Papers

OBJECTIVES: We aimed to (1) quantify changes in discrimination when adding intraoperative data to preoperative data and (2) compare tabular machine learning with feature engineering against a time-aware LSTM-based model.

MATERIALS AND METHODS: Retrospective cohort of 46 204 adults undergoing 57 055 eligible noncardiac surgery in the INSPIRE database. We extracted 38 preoperative and 49 intraoperative variables; acute kidney injury (AKI) was defined by KDIGO serum creatinine criteria and modeled as stage 2/3 postoperative AKI. Models were trained on preoperative-only and combined pre- and intraoperative data. Intraoperative series were summarized using eight statistical features for tabular models or integrated directly …

A Multilevel Analysis Of Hiv Care Outcomes Across Age, Race, And Housing Among United States Women Veterans, Giselle Day, Amber B Amspoker, Alan Z Sheinfil, Liang Chen, Emmanuel Guajardo, Maria E Fernandez, Cici Bauer, Irene Tamí-Maury, Jan Lindsay

Faculty, Staff and Students Publications

Background: Women veterans with HIV represent a growing, diverse population within the Veterans Health Administration (VHA). This study examined HIV care continuum outcomes among women veterans using a multilevel intersectional approach.

Methods: We conducted a retrospective analysis of 1154 women veterans with HIV in VHA care in fiscal year 2022, with outcomes assessed in fiscal year 2023. We applied Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to evaluate how combinations of social positions (age, race/ethnicity, housing status) were associated with HIV outcomes.

Results: MAIHDA models showed that younger age (< 45 years) and being unhoused were consistently associated with lower odds of care engagement and viral suppression than midlife (45-64) and older (65+) housed women veterans. Additionally, predicted probability analyses revealed distinct clustering patterns. Younger non-Hispanic White women consistently ranked among the lowest performing strata across all outcomes, while midlife and older Hispanic and non-Hispanic Black women veterans clustered among the highest. Variance Partition Coefficients from null models were modest (1.8-3.0%). Fully adjusted models showed no remaining between-stratum variance, suggesting that the included social positions explained the observed differences in our dataset.

Conclusions: These findings highlight disparities in HIV care …

Using United States Medicare Program Claims To Identify Reliable Measures Of Low Value Services Influenced By Primary Care Physician Decisions, Chris Fleming, Dmitriy Poznyak, Rhea E. Powell, Claire Erba, Eunhae Shin, Rui Wang, Claire Burkhart, Arkadipta Ghosh, Eugene C. Rich

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Low-value services (LVS) are those that “… provide little to no benefit to patients….”¹ Among an existing set of 31 LVS are invasive procedures not typically performed by primary care physicians (PCPs), and other LVS that may be commonly provided by specialists. To facilitate research on the role of primary care physicians in low-value care, we sought to identify the reliability of two subsets of LVS measures that are more directly subject to PCPs’ decisions. We refer to these as primary care adjacent (“PCA”) LVS measures.

METHODS: Retrospective observational cohort study to identify which of a 31-item LVS …

The Transitional Liver Clinic: Study Protocol For A Stepped-Wedge Cluster Randomized Trial, Lindsay Yoder, Elliot B. Tapper, Richard S. Kalman, Mary Rinella, Nicole Bendin, Manisha Verma, Francis Pike, Naga Chalasani, Neha Nalumasu, Eric S. Orman

Einstein Health Papers

BACKGROUND: Patients with complications of advanced liver disease experience high rates of hospital readmission after discharge. Transitional care models have improved outcomes in other chronic conditions, but their efficacy in liver disease care remains uncertain. This randomized trial evaluates the effectiveness of a tailored transitional care model-the Transitional Liver Clinic (TLC)-in reducing readmissions, improving quality of life, and enhancing patient satisfaction for patients with advanced liver disease.

METHODS: This is a 45-month, stepped-wedge cluster randomized trial enrolling up to 1000 patients with advanced liver disease across 4 academic medical centers. Each site transitions from usual care to the TLC intervention …