Digital Commons Network^™

Sporadic Creutzfeldt-Jakob Disease: A Case Report Of Rapidly Progressive Dementia, Diane Olski, Karissa Charles, Cristin Grant, Courtnee Harpine, Shannon Leonard, Sarah Puim

South Atlantic Division GME Research Day 2025

No abstract provided.

When Probiotics Guidelines Differ: A Practical Guide For Clinicians And Researchers, Geoffrey A Preidis, Hania Szajewska, Marla Cunningham, Howard Bauchner, Daniel J Merenstein

Faculty, Staff and Students Publications

Many professional organizations publish clinical practice guidelines for the use of probiotics in gastrointestinal disorders. Generally, no two guidelines align perfectly, and some differ markedly. These discrepancies occur because clinical practice guidelines are not purely mechanical outputs of data synthesis. They are shaped by structured interpretation, value judgments, and predefined thresholds for uncertainty. These elements become particularly visible when effect sizes are small, heterogeneity is high, and outcomes vary in clinical relevance-as is the case with probiotic research. This article examines why discordance among probiotic guidelines is predictable and provides practical guidance for clinicians who must decide among conflicting recommendations …

Limosilactobacillus Reuteri Promotes Melatonin Release From Human Intestinal Organoids Via 5′Ectonucleotidase Activity, Micah D Forshee, Erika J Nachman, Esha R Shenoy, Heather A Danhof, Ludwig Ermann Lundberg, Stefan Roos, Robert A Britton

Faculty, Staff and Students Publications

Strains of Limosilactobacillus reuteri have been used to prevent or treat various conditions; however, the mechanisms by which they exert beneficial effects are not completely understood. Infant colic is one example in which L. reuteri DSM 17938 reduces clinical symptoms. While the etiology of colic is unknown, abnormal melatonin levels in infants have been suggested as a possible contributor. L. reuteri DSM 17938 has been shown to produce adenosine from AMP via production of the extracellular enzyme 5′ectonucleotidase (5′NT). Adenosine is a potent signaling molecule that impacts several important aspects of host physiology, including the release of melatonin from the …

Is Your Cyst Really A Ganglion Cyst? A Case Report Of Angioleiomyoma Mimicking A Plantar Fascia Cystic Lesion, Christopher Anjorin Ms Dpmc, Joseph Bender Dpm

School of Podiatric Medicine - Student Research

Ganglion cysts are among the most common benign soft tissue masses encountered in podiatric clinical practice, and their diagnosis is often presumed based on location, clinical observation, and transillumination. However, this case highlights a diagnostic idiosyncrasy: a lesion clinically presumed to be a ganglion cyst within the plantar fascia was ultimately identified as an angioleiomyoma following surgical excision and histopathological evaluation. This finding underscores the importance of maintaining a broad differential diagnosis when assessing cystic lesions, particularly those that transilluminate, as benign vascular tumors may closely mimic more common entities in both clinical presentation and imaging. More importantly, what if …

Adolescent And Young Adult Cancer Survivorship: Supportive Care Needs, Resources, And Barriers, Allison Bryn Koplos

Master's Projects and Capstones

Background: Adolescent and young adult (AYA) cancer survivors experience unique physical, psychosocial, developmental, and healthcare-related challenges that often persist beyond treatment completion. Although survivorship resources have expanded, gaps in supportive care needs persist. This scoping review examined the supportive care needs, survivorship resources, and barriers to accessing supportive care among AYA cancer survivors.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA-ScR guidelines. Peer-reviewed literature published between 2000 and 2026 was identified through searches in PubMed and Google Scholar. Studies examining supportive care needs, survivorship resources, or supportive care services …

In-Hospital Mortality Patterns And Readmissions In Patients With Chronic Obstructive Pulmonary Disease: An Analysis Of The Role Of Pulmonary Hypertension, Saad Afzal Khan, Trishna Parikh, Adishwar Rao, Akriti Agrawal, Aarohi Parikh, Farah Kazzaz, Sarah Shin, Harry Karmouty-Quintana, Maulin Patel, Kha Dinh, Bela Patel, Bindu Akkanti

Faculty, Staff and Student Publications

Chronic obstructive pulmonary disease (COPD) may be complicated by pulmonary hypertension (PH). We aimed to understand the impact of PH on in-hospital mortality and quantify the 30-day readmission rate among patients with COPD. For this cross-sectional study, we used the Nationwide Readmissions Database from 2017-2020 to identify adults ≥18 years with COPD. Patients were stratified according to PH diagnosis. Baseline characteristics between groups were compared using the Pearson chi-square test and two-sample t-test. Predictors of in-hospital mortality were determined using multivariate logistic regression analysis adjusted for demographics and confounders. The 30-day readmission rate and prevalence of PH subgroups by baseline …

Methylated Cfdna May Distinguish Between High- And Intermediate-Risk Uveal Melanoma: A Pilot Study, Mike Wu, Daniël P. De Bruyn, Ruben G. Boers, Aaron B. Beasley, Daan M. Hazelaar, Stavros Makrodimitris, Joachim B. Boers, Jolanda Vaarwater, Ronald O.B. De Keizer, Robert M. Verdijk, Nicole C. Naus, Dion Paridaens, Saskia M. Wilting, Elin S. Gray, Wilfred F.J. Van Ijcken, Joost Gribnau, Annelies De Klein, Erwin Brosens, Emine Kiliç

Research outputs 2022 to 2026

Background: Uveal melanoma (UM) is a highly aggressive malignancy with a metastatic risk that depends on the molecular subclass. This subclass can be determined through molecular characterization of tumor-derived tissue. With eye-sparing treatments, tumor tissue is rarely available for molecular testing. We hypothesized that minimal invasive biomarkers such as methylated cell-free DNA (cfDNA) or circulating tumor DNA (ctDNA) can be used for prognosis and monitoring of patients. Methods: Plasma cfDNA was isolated from healthy blood donors (HBDs, N = 19) and UM patients (N = 22). Plasma was collected at baseline (localized disease, N = 13) and during follow-up (metastatic …

Cardiovascular Disease And Fracture Risk In People With Type 2 Diabetes: A Nationwide Matched Case–Control Study, Aksayan Arunanthy Mahalingasivam, Annika Vestergaard Kvist, Joop P. Van Den Bergh, Cassandra Smith, Joshua R. Lewis, Peter Vestergaard, Nicklas Højgaard Hessellund Rasmussen

Research outputs 2022 to 2026

To examine, among people with type 2 diabetes (T2D), whether cardiovascular disease (CVD) phenotypes and cardiovascular medications are associated with any fracture as the primary outcome and major osteoporotic fracture (MOF) as a secondary outcome. Nationwide registry-based matched case–control study in Denmark (2013–2021) among people with T2D. Cases were individuals with T2D who sustained an incident fracture (n = 12,390), and controls were fracture-free individuals with T2D matched 1:3 by age, sex, T2D onset date, and weighted Charlson Comorbidity Index (n = 37,170). The exposures were overall CVD, prespecified clinical CVD phenotypes (acute myocardial infarction (AMI), stroke, heart failure, atrial …

Medication Management And Caregiving Stress Or Benefit In Children With Medical Complexity., Casey O'Hare, Nicole Werner, Makenzie Morgen, Sophie Kooiman, James Feinstein, Michelle A. Chui, Gemma Warner, Anna Jolliff, Brittany Storhoff, Kristan Sondegren, Danielle Gerber, Jens Eickhoff, Ryan J. Coller

Manuscripts, Articles, Book Chapters and Other Papers

This study quantified medication management experiences for children with medical complexity and associations with caregiver stress or benefit. Using data from the MedS@HOME trial, involvement of professional caregivers was associated with increased caregiver benefit, and greater network collective efficacy was associated with increased caregiver benefit and decreased caregiver stress.

TRIAL REGISTRATION: ClinicalTrials.gov, ID NCT05816590.

Application Of Artificial Intelligence (Ai) In Cancer Symptom Management For Adult Cancer Survivors: A Scoping Review, Tao Wang, Haiying Wang, Mengyuan Li, Daniel Bressington, Daniel Terry, Guanjin Wang, Wai Hang Kwok, Jing Yu (Benjamin) Tan

Research outputs 2022 to 2026

Background and aim: Artificial Intelligence (AI) has been increasingly used in cancer survivorship to support symptom management. This scoping review aimed to map existing evidence on AI applications in cancer symptom management for adult cancer survivors, including AI model development, AI-enabled intervention delivery and adoption, symptom targets, key features of the AI approaches used, reported outcomes, influencing factors, and research gaps to inform future priorities.

Method: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Eight electronic databases were comprehensively searched in November 2025 and updated in March 2026. Empirical studies published in …

The Use Of Tens To Help Manage Post-Mastectomy Pain, Alyssa B. Carey, Amanda Giarratano, Verena Gorgi, Lauren Vera

Oncology Rehabilitation in Practice

Transcutaneous electrical nerve stimulation (TENS) has been demonstrated to be an effective non-pharmacological adjunct for postoperative pain management in thoracic surgeries. However, few studies have examined its benefits in managing post-mastectomy pain. This study found that TENS provided positive effects on postoperative pain control, which were associated with improved physical and psychological outcomes. Overall, TENS appears to be a safe and effective modality for managing acute postmastectomy pain.

Evaluating A Peer Support Program: Impact On Peer Supporters In A Tertiary Care Children’S Hospital, Lauren R. Anderson, Heather Dekeyser, Sonja I. Ziniel, Michele Loi, Emily Muther, Kami Wolfe Schneider, Christine Waasdorp Hurtado, Jo Vogeli, Jennifer Reese

Journal of Wellness

Introduction: Healthcare workers experience emotional distress following poor patient outcomes, which can negatively impact wellbeing and retention. Peer support programs are an evidence-based approach to mitigating distress through provision of confidential counseling by a trained peer. However, data on impact of participation on peer supporters is limited. We aimed to evaluate and describe the peer supporters’ experience at our tertiary children’s hospital.

Methods: A web-based survey was developed with input from key partners. Content was reviewed via cognitive interviews. The survey was administered to 167 trained peer supporters during the spring of 2022. Demographic comparison data were gathered from an …

A Conceptual Framework For Clinical Quality Oversight In Telehealth-Enabled Home-Based Urgent Care, Taylor Spencer, Jason P. Williams

HCA Healthcare Journal of Medicine

Background

Home-based urgent care serving frail older adults should aspire to high-quality clinical care with optimal patient outcomes. However, monitoring and ensuring this quality can be challenging. For example, telemedicine and value-based frameworks introduce substantial complexity to clinical quality monitoring.

Purpose

We describe the conceptual framework for a multidimensional quality monitoring program within a national home-based urgent care model.

Framework Description

Medical care was delivered via a multi-state home-based primary, palliative, and urgent care practice serving medically complex Medicare Advantage (MA) populations. Our model of care incorporated distributed clinical and operational teams delivering 24/7 care via telephonic triage, video-enabled encounters, …

Assessment Of Hypoglycemia Management In Acute Care Hospitals, Carley Warren, Christina Wing, Chenette Burks, Brooke Schmidt, Adam Hasse

HCA Healthcare Journal of Medicine

Background

Hypoglycemia is a common and potentially preventable complication among hospitalized patients, particularly those receiving insulin or other glucose-lowering therapies. Delayed recognition and inconsistent management can increase adverse outcomes. Although protocols exist, variability in treatment selection and timing may influence the likelihood of returning to normoglycemia. Understanding these patterns is critical to optimizing patient safety in acute care settings.

Methods

This retrospective review evaluated hypoglycemia management in adult inpatients across acute care hospitals within a large health system. Patients were included if they were aged 18 years or older, were hospitalized within the health system, and experienced a hypoglycemic event, …

Time To Antibiotic Administration In The Treatment Of Sepsis: A Retrospective Cohort Study, Dennis Anthony Cardriche, Grayson Carter, Thomas Matese

HCA Healthcare Journal of Medicine

Background

The 2026 Surviving Sepsis Campaign (SSC) guidelines recommend antimicrobial therapy within 1 hour for probable septic shock, while the Centers for Medicare and Medicaid Services (CMS) mandates a 3-hour window. Current literature presents conflicting evidence on whether these universal time thresholds yield a definitive survival benefit. This study aims to evaluate the real-world impact of delayed antibiotic administration on patient mortality and length of stay (LOS).

Methods

A retrospective cohort study was conducted analyzing 62 153 adult encounters with severe sepsis or septic shock at emergency departments (EDs) between December 31, 2023, and December 31, 2025. Time to first …

The Use Of Infra-Red Spectroscopy To Assess Intact Skin Of Various Skin Tones, Mary Lee A. Potter, Stacie Sosa, Charlott Polm, Sherry Campton, Wisam Salameh, Ronnie Klein, Yaniv Cohen

HCA Healthcare Journal of Medicine

Background

Pressure injuries (PI) continue to be a serious medical complication in the acute care setting. Industry leaders advocate for the use of objective technologies to provide accurate and quantifiable skin assessments for all patients across diverse skin tones. The Infra-Red Spectroscopy Scanner (IRSS) is a novel non-invasive decision support system (DSS) electro-optic technology that uses near infra-red spectroscopy to examine and assess physical and chemical changes prior to visual skin breakdown in real-time.

Methods

A 2-phase prospective open-label pilot device study was launched under protocol IRM-02-1123 (USA version 3.0, November 1, 2023). In both Phase 1 and Phase 2, …

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

A Nurse-Driven Escalation In Trauma Team Activation Reduces Mortality Of Injured Patients, Darrell L. Hunt, Yingxian Liu, Jordan S. Rahm, Bailey Segura, Mercedes Huens, Emily Lopez, Esther Krinsky, Joe Spinell, Andrea Palmer

HCA Healthcare Journal of Medicine

Background

There is a dearth of literature examining the clinical outcomes of injured patients who experience physiological deterioration in the emergency department (ED). At our trauma center, injured patients who develop hemodynamic, respiratory, or mental status instability after arrival are retriaged and upgraded to a full trauma team activation (fTA). The purpose of this study was to compare the clinical outcomes of patients with fTA based on prehospital signs and symptoms (initial) versus upgraded fTA patients.

Methods

This was a single-center, retrospective cohort study of injured patients presenting to a tertiary trauma center between June 1, 2022, and June 30, …

Making Diagnostic Uncertainty Visible At Intensive Care Unit Transitions: A Narrative Review Of Diagnostic Pause Strategies, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Diagnostic error is a significant patient safety issue in critical care. However, it is often difficult to detect during ongoing care. Patients in the Intensive Care Unit (ICU) often have incomplete histories, overlapping symptoms, changing physiology, and concurrent issues. During ICU transitions, patient diagnoses are often reported without clear information on diagnostic confidence, potential alternative diagnoses, pending results, or triggers needing review.

Methods

This clinical narrative review explored diagnostic uncertainty at ICU transitions, specifically those during ICU-to-ward transfers or unplanned escalations to the ICU. A targeted literature search identified studies of adult ICU diagnostic errors, ICU transition safety, ICU-PAUSE …

Beyond Bed Numbers: A Proposed Quality Improvement Framework For Reviewing Icu Acuity, Workload, And Medical Staffing, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Intensive care unit (ICU) medical staffing is often planned using bed numbers or fixed ratios. These counts do not describe the work required when patients deteriorate, urgent tasks overlap, or clinicians have duties outside the unit. A structured review could help teams discuss whether available cover can meet these demands.

Methods

We undertook a targeted narrative synthesis of adult ICU staffing guidance, acuity and workload measures, physician workload studies, and capacity-strain research available through 8 September 2026. We examined study settings, findings, and limitations to inform the framework domains. The authors proposed the review prompts and response options. No …

Brief, Handoff, Backbrief, Forecast, Review: A Communication Cycle For Safer Trauma And Surgical Intensive Care Unit Transitions, Constantine Stephens, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Safety in trauma and surgical critical care is inseparable from the reliability of communication at transitions of care. Handoffs are recurrent, high-risk moments in which teams transfer not only information but responsibility, prioritization, uncertainty, and contingency planning; failures at these points propagate into omissions, delayed escalation, and preventable harm to patients and strain on the workforce. Structured handoff tools improve completeness and clarity but inconsistently change hard clinical endpoints, and tools alone do not create the culture of safety on which high-reliability organizations (HROs) depend. This narrative review synthesizes civilian handoff research, human-factors and HRO theory, situation-awareness, psychological safety, trauma …

Bathrooms As A Patient Safety Blind Spot In Emergency Departments: A Narrative Review And Nursing Practice Framework, Carmelo Villani

HCA Healthcare Journal of Medicine

Background

Emergency department (ED) bathrooms preserve privacy and dignity but interrupt direct observation. Risks described across clinical publications and professional guidance include falls, unrecognized deterioration, overdose, hazardous ingestion, infection, inaccessible environments, and unmet elimination needs. This review integrated those risks and translated them into a nursing practice framework.

Methods

For the structured narrative review, PubMed/MEDLINE, CINAHL Plus, and Scopus were searched on July 30, 2026, without date, language, age, or publication-type filters. Backward and forward citation chasing and a targeted search for professional documents supplemented database searching. Publications were categorized by ED relevance and synthesized thematically. Professional guidance was analyzed …

Development And Implementation Of A Scholarly Curriculum For Internal Medicine Residents And Subspecialty Fellows, Yuri Matusov, Hawas Kaderi, Liza Raffi, Louie Cao, Jacqueline Lee, Mariko Ishimori, Odelia Cooper

Graduate Medical Education Research Journal

Background. To create and assess the efficacy of a standardized curriculum for trainees in the core competency of critical appraisal of medical literature.

Methods. We implemented a 10-hour scholarly lecture curriculum, in 1-hour blocks, over 1 academic year for postgraduate trainees in internal medicine (IM) and IM subspecialties at a single major academic medical center. The aims of the curriculum were to increase trainee comfort with clinical research methodology, to place this methodology in the context of historical and current ethical challenges, to provide trainees with guidance on how to conduct clinical research at the institutional level, and to provide …

Asteroid Hyalosis Mimicking Vitreous Hemorrhage On Point-Of-Care Ultrasound Following Blunt Ocular Trauma: A Case Report, Obiaara Ukah, Jared Marx

Graduate Medical Education Research Journal

Background. Ocular complaints account for approximately 1.5% of emergency department (ED) visits, and point-of-care ultrasound (POCUS) is a valuable tool for evaluating posterior chamber pathology, including vitreous hemorrhage (VH), retinal detachment, and vitreous detachment. However, benign conditions may mimic these pathologies and create diagnostic uncertainty. We describe a case of asteroid hyalosis (AH), a benign vitreous condition that was initially mistaken for vitreous hemorrhage on ocular POCUS following blunt ocular trauma. This case highlights an uncommon sonographic mimic of VH and contributes to the emergency medicine literature by emphasizing ultrasound features that may help distinguish AH from true posterior chamber …

Emergent Endovascular Therapy For Malignant Superior Vena Cava Syndrome Complicated By Extensive Central Venous Thrombosis: A Case Report, Austin Johnson, Andrew Mezher, Ehab Saad Aldin, Lei Yu

Graduate Medical Education Research Journal

Background. Superior vena cava (SVC) syndrome is a potentially life-threatening condition caused by obstruction of venous return through the SVC, most commonly due to malignancy. Although endovascular therapy (ET) has emerged as an effective treatment for rapid symptom relief, malignant SVC syndrome complicated by extensive central venous thrombosis and respiratory failure remains a high-acuity presentation requiring urgent intervention. This case highlights the role of emergent ET as a life-saving bridge to definitive oncologic treatment in critically ill patients.

Case. A 58-year-old male with squamous cell carcinoma of the lung presented with acute respiratory failure, facial and upper extremity swelling, and …

Iatrogenic Popliteus Tendon Injury During Total Knee Arthroplasty, Saswat Samant, Bibhudutta Sahoo, Saurav Narayan Nanda, Suman Mishra, Satya Ranjan Patra, Himanshu Mishra

Graduate Medical Education Research Journal

Background. The popliteus tendon (PT) plays a role in knee unlocking and posterolateral stability, yet the clinical impact of its iatrogenic injury during total knee replacement (TKR) remains poorly defined. This study aimed to evaluate the outcomes of patients with documented intraoperative PT injury during posterior-stabilised TKR.

Methods. A retrospective review was conducted on 111 varus knees undergoing posterior-stabilised TKR. Among these, seven cases (6.3%) of intraoperative PT injury were identified. The cohort had a mean age of 71 years and an average preoperative varus deformity of 14°. PT repair was performed in two of the seven injured cases.

Results. …

Systemic Treatment Considerations For Psoriasis In Alpha-Gal Syndrome: A Case Report And Ingredient Review, Emily Saurborn, Ian Depew, Madelyn Ross, Mckenzie Lambiotte, Shane Cook

Marshall Journal of Medicine

Background: Psoriasis is a chronic skin condition characterized by an overactive immune system, leading to increased keratinocyte proliferation and angiogenesis. Treatment ranges from topical solutions to systemic therapy and lastly, biologics. However, the latter options are typically manufactured with mammalian-derived ingredients. Alpha-gal syndrome (AGS) is an acquired IgE-mediated hypersensitivity reaction to galactose-alpha-1,3-galactose, an enzyme required for digesting carbohydrates in mammalian products. In addition to dietary avoidance of mammalian products, patients with AGS may need to avoid certain medications due to their formulations.

Case Presentation: We present a case of a 53-year-old female with a severe alpha-gal allergy evaluated in the …

Association Between Echocardiographic Epicardial Adipose Tissue Thickness And Atrial Fibrillation In A Single-Centre Pakistani Cohort, Ateeb Mahmood Khan, Fateh Ali Tipoo Sultan, Aiman Sultan, Adeel Khoja

Journal of the Saudi Heart Association

Objectives: To assess the association between echocardiographic epicardial adipose tissue (EAT) thickness and atrial fibrillation (AF) in a single-centre Pakistani cohort of patients referred for transthoracic echocardiography (TTE).

Methods: Patients referred for TTE at Aga Khan University Hospital (AKUH), Karachi, were prospectively enrolled over a six-month period (1 September 2024 – 28 February 2025) using a convenience sampling approach; nearly all patients referred for TTE with AF during this period were captured, while patients in sinus rhythm were enrolled by convenience sampling alongside them, in order to ensure an adequate number of AF cases for comparison. EAT was measured in …

Cardiac Marker Levels In Patients With Sickle Cell Disease During Emergency Room Visits: A Retrospective Study, Adel F. Al-Marzouki, Osman Radhwi, Nadine Alharbi, Sondos Jar, Weam Bajunaid, Abdulaziz Alzahrani, Majed Alhuzali, Sultan Aljuaid, Naif Abdulaziz Meighrbl

Journal of the Saudi Heart Association

Background: Millions of people worldwide suffer from a genetic hemoglobinopathy known as sickle cell disease (SCD). It is a long-term condition marked by progressive multiorgan failure. Among SCD patients, cardiovascular complications are the main leading cause of death. Cardiovascular complications raise cardiac markers levels as well as sickle cell vaso-occlusive crisis (VOC). This makes it challenging to determine the source. This research aims to identify the association between cardiac markers and myocardial infarction in SCD patients at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia.

Material and Method: This retrospective study was conducted from June 2022 to March 2023. …

Recognizing Coronary Artery Disease In Women, Krista Ohmie Pa-C, Cck, Aacc

Lynchburg Journal of Medical Science

The purpose of this review is to identify sex-specific factors in the prevention, diagnosis, and treatment of cardiovascular disease in women as it continues to be the number one cause of their mortality. A search of the literature was conducted using PubMed as well as resources from the American College of Cardiology and the American Heart Association with multiple articles identified for use. The risk of cardiovascular disease in women is affected by traditional risk factors such as hypertension and diabetes, but is compounded by length of estrogen exposure, pregnancy, and higher rates of systemic inflammation. Systemic barriers such as …