Digital Commons Network^™

Training Apart, Together: Team Dynamics In Individual Sports And Surgical Residency, W. Jack Palmer, Dylan Bertoni, Elizabeth E. Cottrill, Colin T. Huntley

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Surgeons in training share notable parallels with competitive athletes, including rigorous training, skill specialization, and functioning under pressure. Surgical educators have leveraged this comparison, incorporating techniques from sports psychology, such as mental imagery and mindfulness, to improve trainees' individual performance and well-being. Surgical trainees and athletes both rely on effective teamwork for optimal outcomes, suggesting that residency leaders can glean valuable team-level insights from sports psychology. This article examines how the structure of surgical residency influences team dynamics, using concepts from sports psychology to identify evidence-based strategies for improving program cohesion and resident well-being. The surgical literature typically conceptualizes surgery …

Exploring The Contextual Relationships Between Match Day Load And Recovery Biomarkers In Professional Soccer Players, Carina Hanson-Evans, Ryland Morgans, Rafael Oliveira, Jule Scholten, Roi Gil, Ben Ryan, Jon Oliver, Piotr Żmijewski, Michael G. Hughes

Baltic Journal of Health and Physical Activity

Background: This study examined the relationship between match-day (MD) load and contextual factors on recovery biomarkers in professional soccer players across the 2024/2025 competitive season. Materials and Methods: Twenty-six male professional soccer players provided blood samples following 38 competitive matches. High-sensitivity C-Reactive Protein (hs-CRP), Free-Oxygen Radicals Test (FORT), Free-Oxygen Radicals Defence Test (FORD) and Oxidative Stress Index (OSI) were analyzed. Physical MD load was measured via a Global Positioning System (GPS). Results: Differences in High-Load vs Low-Load matches did not significantly influence post-match levels of hs-CRP, FORD, FORT or OSI. Increased high-intensity running and elevated inflammation, with non-significant moderate-to-large effects …

Next Steps In Advancing Pediatric Care In Southern Nevada, The Lincy Institute

Lincy Institute Events

The Lincy Institute released new research evaluating the Southern Nevada pediatric care ecosystem. The report, "An Evaluation of Southern Nevada’s Pediatric Care Ecosystem," offers recommendations to develop a stronger and more coordinated pediatric care ecosystem before the stand-alone children’s hospital being developed by Intermountain Health opens in 2030 and identifies the components of an integrated statewide network to provide all of Nevada’s children with access to high-quality care. The event also featured panel discussions with pediatric care providers and policymakers.

Panel 1 - Pediatric Care Providers

Moderator — Tina Quigley, Project Facilitator, The Lincy Institute

Panelists — Lisa …

An Evaluation Of Southern Nevada’S Pediatric Care Ecosystem, David Damore, Tina Quigley, Nick Fiore

Policy Briefs and Reports

In 2024, The Lincy Institute and the Nevada Health and Bioscience Corporation released a report prepared by the consulting firm Tripp Umbach detailing the case for a stand-alone children’s hospital in Southern Nevada. Shortly thereafter, Intermountain Health announced it would build Nevada’s first such facility in Las Vegas, expected to open in 2030. To complement the hospital’s development, The Lincy Institute undertook an independent evaluation of the regional pediatric care landscape. The analysis draws on secondary data and discussions with advocates, health system administrators, practitioners, and providers. The report examines:

• Fiscal, resource, and workforce challenges underlying Nevada’s poor population-level pediatric …

Reversible Microvascular Ischemia With St-Segment Elevation: An Underrecognized Manifestation Of Antibody-Mediated Rejection In Cardiac Allograft Recipients, Jonathan Ahn, Justin Daneshrad, Liset Stoletniy, Dmitry Abramov

The VAD Journal

Electrocardiographic manifestations of cardiac allograft rejection are often subtle, and stress-induced ST-segment elevation associated with antibody-mediated rejection (AMR) is rarely reported. We describe a 34-year-old heart transplant recipient with progressive exertional angina, nonobstructive coronary disease on angiography, and exercise-induced ST-segment elevation in lead augmented vector right, high-lateral leads I, and augmented voltage left, along with diffuse ST-segment depressions, hypotension, and transient ventricular tachycardia. Concurrent emergence of complement-binding donor-specific antibodies with high mean fluorescence intensity raised concern for AMR, prompting treatment with corticosteroids, plasma exchange, and intravenous immunoglobulin despite the absence of biopsy confirmation. After therapy, symptoms, exercise-induced ischemic electrocardiographic abnormalities, …

Beyond Electromyography: A Systematic Review And Meta-Analysis Of Ai Enabled Wearables For Neuromuscular Assessment In Sports Medicine And Rehabilitation, Dariusz T. Skalski, Michał Spieszny, Łukasz Jaworski, Marcin Żak, Artur Terbalyan, Marlena Stawiarska, Wirginia Likus, Adam Maszczyk

Baltic Journal of Health and Physical Activity

Background: Conventional laboratory based EMG systems constrain neuromuscular assessment to controlled environments, limiting ecological validity in sport and rehabilitation. While AI enabled wearable sensor systems, including surface EMG (sEMG), high density EMG (HD-EMG), inertial measurement units (IMUs), and multimodal configurations, have expanded ambulatory monitoring capabilities, no prior meta-analysis has quantitatively synthesized their agreement with laboratory grade comparators or examined the moderating roles of sensor class and task domain. Objective: To determine the overall agreement between AI enabled wearable neuromuscular systems and laboratory benchmarks; to examine sensor class and task domain as moderators of measurement fidelity; to evaluate multimodal gain over …

Individual Host Variation In Single-Cell Responses To Enteroaggregative Escherichia Coli Infection Modeled With Human Colon Organoids, Ling Qiu, Tajhal D Patel, Hannah E Jones, Cristian Coarfa, Anthony W Maresso

Faculty, Staff and Students Publications

Enteroaggregative Escherichia coli (EAEC) is a leading cause of diarrhea worldwide. Interestingly, EAEC disease outcomes vary dramatically among infected individuals, ranging from asymptomatic colonization to acute and chronic diarrhea. While previous research has focused on EAEC virulence factors, emerging evidence suggests that host genetic and cellular background may be equally important in determining disease susceptibility. To understand host-driven disease heterogeneity, we performed single-cell RNA sequencing on human colon organoids (HCOs) derived from three healthy adult donors following EAEC 042 infection. Surprisingly, despite comparable EAEC adherence across donors, we observed striking donor-specific responses to infection at multiple levels. A total of …

Eeg-Emg Coupling And Functional Neuroplasticity In Elite Combat Athletes: Effects Of Neurofeedback Training On Corticomuscular Coherence And Performance, Alicja Markiel, Kinga Łosińska, Marcin Żak, Adam Maszczyk

Baltic Journal of Health and Physical Activity

Background: Neurofeedback training has gained attention as a neuroplasticity based intervention for athletic performance, yet pathways linking cortical oscillatory modulation to neuromuscular adaptation and strength remain poorly characterized in elite combat athletes. Objective: This study examines whether EEG neurofeedback targeting sensorimotor alpha upregulation and frontal theta/delta modulation enhances cortico-muscular coherence, neuromuscular function, and maximal strength in elite MMA athletes. Methods: Thirty elite male MMA athletes (n = 10/arm) were randomized to intensive neurofeedback (E20G, 20 sessions), abbreviated neurofeedback (E15G, 15 sessions), or sham control. EEG spectral indices, EMG parameters (RMS, MF, iEMG, onset latency), beta band CMC, and maximal strength …

Intimate Partner Violence And Child Wasting Across Countries: An Ecological Cross-Sectional Study, Wanri Lumbanraja, I Ketut Kasta Arya Wijaya, Ruben Cornelius Siagian

Journal of Indonesian Health Policy and Administration

Intimate partner violence (IPV) is a public health issue that can affect the well-being of women, their families, and the child-rearing environment. Meanwhile, wasting in under-five children reflects acute malnutrition linked to food insecurity, infectious diseases, poverty, and access to healthcare services. This study aimed to analyze the relationship between the prevalence of IPV among women in the past 12 months and the prevalence of wasting in children under the age of five at the national level. This study addresses the gap in cross-national research, which remains limited in linking IPV as an indicator of social vulnerability with wasting as …

Palopegteriparatide For Adults With Chronic Hypoparathyroidism: Skeletal Dynamics Through 3 Years Of The Phase 2 Path Forward Trial, Mishaela Rubin, Bart Clarke, Lorenz Hofbauer, Aliya Khan, Peter Schwarz, Tamara Vokes, Intekhab Ahmed, Andrea Palermo, Filomena Cetani, Uberto Pagotto, Carol Zhao, Michael Ominsky, Bryant Lai, Jenny Ukena, Aimee Shu, Lars Rejnmark

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

Hypoparathyroidism is an endocrine disease caused by insufficient levels of PTH, which acts directly on bone and kidney and indirectly on the intestine to regulate calcium and phosphate balance. In clinical trials, palopegteriparatide (TransCon PTH) treatment enabled independence from conventional therapy (no active vitamin D, ≤600 mg/d calcium) and maintained serum biochemistries within normal ranges. The current analyses describe patterns of change in BMD, serum bone turnover markers, and serum and urine calcium in adults with chronic hypoparathyroidism treated with palopegteriparatide through 3 years of the PaTH Forward trial. Baseline BMD Z-scores for the LS, TH, FN, and 1/3 distal …

Management Of Non-Survivable Head Trauma: Opportunities For Improvement, Sanjana R. Salwi, Mackenzie D. Castellanos, Therese Murphy, Pious D. Patel, Sonia Ajmera, Alex P. Vaz, Connor A. Wathen, Niels D. Martin, Monisha A. Kumar, James M. Schuster, Dmitriy Petrov

Department of Neurosurgery Faculty Papers

BACKGROUND: Managing patients with non-survivable head trauma who do not meet brain death criteria presents significant ethical and clinical challenges. Decisions frequently fall to surrogates with limited guidance, particularly when organ donation status is unknown. This study assessed physician perspectives on communication, interventions, and institutional factors.

METHODS: We conducted a national survey of academic neurosurgery, trauma surgery, and neurocritical care programs. Items examined communication barriers, interventions by donor status, institutional support, and a dissonance measure for interventions viewed as inappropriate.

RESULTS: A total of 133 physicians responded. Top communication barriers were medical literacy, unclear patient values, and intrafamily conflict. Physicians …

Evaluation Of Radial Artery Anatomy With Various Anatomical Variants In Patients Undergoing Transradial Q1 Catheterization, Nisarg Desai, Sharadkumar Jain, Kunal Parwani, Pooja Vyas, Yaqub Sidatar

Journal of the Saudi Heart Association

Objectives: This study aimed to determine the incidence of radial artery anomalies in a large cohort of patients undergoing TRA and to evaluate their specific impact as predictors of procedural failure and access site complications.                                                                                  

  Methods: This prospective, observational, single-center study enrolled 1000 consecutive patients undergoing coronary angiography or intervention via TRA between 2022 and 2024. Radial artery anatomy was assessed using retrograde radial arteriography immediately following sheath insertion. Anatomical variants were categorized into high bifurcation (origin proximal to the cubital fossa), Radial artery loops (full 360-degree curvature), Tortuosity (curve of more than 45 degrees in the vessel), Narrow calliber, …

Feasibility And Acceptability Of Perioperative Application Of Biofeedback-Based Virtual Reality Vs Control For Pain And Anxiety In Children And Adolescents Undergoing Surgery: Pilot Randomized Controlled Trial, Anna Lin, Brenna Rachwal, Lindsey Asti, Zandantsetseg Orgil, Isabela Santiago, Lili Ding, Susmita Kashikar-Zuck, Christopher King, Sara Williams, William Black, Peter Minneci, Vanessa Olbrecht

Department of Anesthesiology Faculty Papers

BACKGROUND: The impact of biofeedback-based virtual reality (VR-BF) on pain and anxiety in pediatric surgical patients remains unexplored.

OBJECTIVE: The objective of this study was to evaluate the feasibility and acceptability of perioperative VR-BF use in children and adolescents.

METHODS: We performed a single-blind, 2-arm, randomized pilot trial. Children aged 12 to 18 years undergoing surgery with expected moderate-to-severe postoperative pain and more than 1 overnight admission were randomized (1:1) to the intervention or control group. Participants in the intervention group received VR-BF using ForeVR (functional outcome response to engaging virtual reality [VR]), a novel, gamified digital intervention that integrates …

Successful Treatment Of Recurrent Epithelioid Trophoblastic Tumor (Ett) With Pembrolizumab After Pembrolizumab: A Case Report And Review Of Literature In Treatment Of Ett, Sarah Mokma, Sarah Alnaif, Nicholas Cardillo

Abington Jefferson Health Papers

BACKGROUND: Epithelioid Trophoblastic Tumors (ETT) are rare, which makes an optimal treatment regimen difficult to determine. Since PD-L1 is expressed in placental tissue and in gestational trophoblastic neoplasia (GTN), immunotherapies such as pembrolizumab have been proposed as possible treatments.

CASE PRESENTATION: The case presented is a 50-year-old postmenopausal female who presented with postmenopausal bleeding and a large, fungating cervical mass. Cervical biopsies confirmed ETT. The patient underwent primary debulking surgery with radical abdominal hysterectomy, bilateral salpingo-oophorectomy, and sigmoid colon resection. The patient was diagnosed with a FIGO Stage IV ETT due to tumor extension to sigmoid colon with a high-risk …

Evaluating The Readability Of Online Patient Education Materials For Avascular Necrosis, Gabriella B. Smith, Grady H. Hofmann, Anna V. Gussner, Nicole S. Pham, Nneoma O. Duru, Kevin G. Shea

Journal of Patient-Centered Research and Reviews

Purpose: Avascular necrosis (AVN) is a progressive pathology affecting pediatric and adult patients. Given the risks of joint collapse and surgery, patients frequently research their condition online. The average reading level in the United States is approximately the eighth-grade level. The National Institutes of Health (NIH) recommend that patient materials be written at or below a sixth-grade level. This study aimed to assess the readability and quality of online AVN resources.

Methods: A Google search using the terms “avascular necrosis” and “osteonecrosis” was conducted, and firstpage results were aggregated. Flesch-Kincaid Grade Level, Gunning Fog Index, and Flesch Reading Ease tests …

A Mixed Methods Study Of Inpatients’ Experiences, Priorities, And Health-Related Quality Of Life During High- Flow Nasal Cannula Therapy, Cintamani H. Ellsworth, Rebecca S. Bartlett

Journal of Patient-Centered Research and Reviews

Purpose: High-flow nasal cannula (HFNC) is an oxygen delivery method with numerous benefits for severely ill patients. There is a paucity of research focused on the perspectives of patients receiving HFNC oxygen therapy. This study aimed to engage with patients to gain a clearer understanding of their experiences, priorities, and health-related quality of life.

Methods: A cross-sectional, mixed methods study was completed with 10 adult inpatients who had received HFNC oxygen therapy during their hospital admission. Semi-structured interviews and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale were used to identify participant perceptions of their physical and …

Knowledge, Practice And Perceived Barriers Of Healthcare Provider Adherence To The Notifiable Disease Surveillance System (Ndss) In Government Hospitals And Primary Healthcare Centers In Jazan, Saudi Arabia: A Cross-Sectional Study, Moatasem F. Hakmi, Alaa Mathkour, Yousef Zahrani, Rayan I. Binduhayyim, Saad S. Alqahtani, Muhammad Z. Iqbal

Saudi Medical Journal

Objective: To assess and compare healthcare providers' understanding of the Notifiable Disease Surveillance System (NDSS), alongside reported and perceived challenges, across public hospitals and primary healthcare centers in Jazan, Kingdom of Saudi Arabia.
Methods: A cross-sectional study was conducted between 10 January 2025 and 30 December 2025 among health care providers at Jazan hospitals and primary healthcare centers (PHCs) (n = 420). Data were collected via structured self-administered questionnaire that included the following sections: demographic data, knowledge of the NDSS, reporting practices, competency of the Health Electronic Surveillance Network (HESN) and perceived barriers. Descriptive and inferential statistics were used to …

Cranial Mri In Girls With Central Precocious Puberty: Clinical Characteristics And Predictors Of Abnormal Findings, Fahad N. Al Juraibah, Mashael M. Alharbi, Reem D. Alharbi, Joud S. Albaraki, Sarah S. Aldharman, Hala A. Alghamdi, Nagarajkumar Yenugadhati, Abdullah I. Alhammad, Angham N. Almutair, Ibrahim A. Al Alwan

Saudi Medical Journal

Objectives: To describe the clinical profile of girls with central precocious puberty (CPP) and determine the factors associated with abnormal cranial magnetic resonance imaging (MRI) findings.
Methods: This retrospective study included girls aged 8 years or younger with a diagnosis of CPP who received care at King Abdullah Specialized Children's Hospital in Riyadh, Kingdom of Saudi Arabia, between 2015 and 2023. Data on clinical presentation, biochemical results, imaging findings, and treatment were obtained from medical records. Logistic regression analysis was performed to determine variables associated with MRI utilization and the occurrence of abnormal MRI findings.
Results: The cohort comprised 70 …

Advancing Impact: A National Approach To Knowledge Translation In Saudi Arabia-The Saudi National Institute Of Health Experience, Maha M. Aleid, Manar A. Alharbi, Amal N. Almadouj, Ahmad I. Alrawaji, Lamia A. Alhaqbani, Fars K. Alanazi

Saudi Medical Journal

Objectives: To present a reproducible national model for translating research findings into evidence-based clinical practice guidelines.
Methods: The Saudi National Institute of Health launched the initiative titled ``Transforming the Outcomes of Published Health Research into Medical Guidelines that Enhance Medical Practices to Improve the Quality of Human Health'' on February 3, 2025. The initiative aimed to identify and assess research outcomes published between January 1, 2020, and December 31, 2024 across 6 predefined thematic tracks relevant to the Saudi population. Eligible publications were collected within one month after the submission portal opened. Following closure of portal, all submissions were evaluated …

Estimating Radiation Dose And Proposing Institutional Diagnostic Reference Levels For Paediatric Fluoroscopy Of Micturating Cystourethrogram: Age- And Weight - Specific Comparisons, Khalid M. Aloufi

Saudi Medical Journal

Objective: To compare age- and weight-specific methods used to estimate radiation doses and to propose institutional diagnostic reference levels (DRLs) for paediatric fluoroscopy of micturating cystourethrogram (MCUG).
Methods: In this retrospective study, MCUG fluoroscopy parameters were gathered for 100 paediatric patients from July 2025 to January 2026. The data included the MCUG paediatric procedures for patients aged 0–15 years. The data were categorized into paediatric weight- and age-specific groups. Paediatric weight-specific groups were ≤ 5, 5 < – 10, 10 < – 20, and >20 kg, and paediatric age-specific groups were ≤ 1, 1 < – 5, 5 < – 10, and < 10 – 15 years old.
Results: Differences were observed in dose area product (DAP) and DRL results for age- …

Potential Drug–Drug Interactions In Patients Undergoing Hemodialysis: A Retrospective Observational Study, Buthainah B. Al-Ammash, Fawaz A. Alharbi, Omar D. Al-Hejaili, Mansour A. Mahmoud, Mazin A. A. Abdelaziz, Alaa I. Alrais, Shahad A. Albakri, Ibrahim F. Alharbi, Sara A. Felemban, Abdullah H. Almatrafi, Salman A. Alabdali, Yaser M. Alahmadi

Saudi Medical Journal

Objectives: To evaluate the prevalence, characteristics, and determinants of potential drug–drug interactions (pDDIs) among patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) at a tertiary care hospital in Al-Madinah Al-Monawara, Kingdom of Saudi Arabia.
Methods: Data for this retrospective observational study were extracted from the electronic medical records of adult patients (≥ 18 years) diagnosed with ESRD and receiving hemodialysis (HD) between October 2022 and March 2023. The pDDIs were identified and classified using Lexicomp® (Wolters Kluwer, Alphen aan den Rijn, Netherlands). Descriptive statistics summarized patient characteristics and pDDIs, and univariate logistic regression was implemented to investigate the determinants …

Drooling In Children With Cerebral Palsy: A Narrative Review Of The Current Management Landscape, Kamel A. Alenazi

Saudi Medical Journal

Children with developmental or neurological disorders, such as cerebral palsy, present with impaired motor function, resulting in impaired swallowing, feeding, and drooling. The prevalence of chronic drooling radically changes from 0.5% in children >4 years to 60% in children with neurological ailments. Drooling can have a serious impact on the quality of life of affected children, which can create a sense of isolation and refusal by peers. In addition, drooling results in not only financial but also considerable emotional turmoil for caregivers of affected children, who are frequently confronted with difficulty managing the underlying neurological impairment of their child. In …

Scoping Review Of Mental Health Outcomes Of Cosmetic Procedures Among The Saudi Population, Hessah Alzahrani

Saudi Medical Journal

Objective: To comprehensively examine the mental health outcomes associated with cosmetic procedures among the Saudi population, with a particular focus on psychological well-being, self-esteem, anxiety, body image, and quality of life.
Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. A structured search was performed across international databases, including PubMed, PsycINFO, Scopus, Web of Science, and Google Scholar, in addition to national Arabic databases. Studies investigating the psychological outcomes of both surgical (rhinoplasty and body contouring) and …

Quality, Patient Experience, And Service Gaps In Home Healthcare In Saudi Arabia: A Systematic Review Aligned With Vision 2030, Eman Alawad, Rasha M. Mahrous, Lubna A. Elshaib

Saudi Medical Journal

Objectives: To assess the quality of home healthcare (HHC) services, patient experience, and existing service gaps in Kingdom of Saudi Arabia.
Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. PubMed, MEDLINE, Scopus, Web of Science, CINAHL, and Google Scholar were searched for studies published between January 2011 and January 2025. Eligible studies included observational, qualitative, mixed-methods, and interventional studies conducted in Saudi Arabia that examined home healthcare quality, patient or caregiver experience, or service delivery gaps. Two reviewers independently screened studies, extracted data, and assessed methodological quality …

Implementing Diagnosis-Related Groups For Value-Based Healthcare In Saudi Arabia: A Systematic Review Of Evidence On Barriers And Facilitators, Racha M. Naim, Michelle A. Badore, Justin J. Needle

Saudi Medical Journal

Objective: To examine the barriers and facilitators to implementing Diagnosis-related groups (DRGs) in Kingdom of Saudi Arabia, aiming to identify actionable insights for policymakers and stakeholders to advance value-based healthcare (VBHC) adoption effectively.
Methods: A systematic search of bibliographic databases and relevant grey literature was conducted. Data were synthesized using the Consolidated Framework for Implementation Research (CFIR) to categorize barriers and facilitators across 5 domains.
Results: A total of 10 studies met the eligibility criteria. Key facilitators included the adoption of patient classification systems, standardized data sets, government policy support, and the availability of advanced health information systems. Barriers included …

From Bench To Bedside: Evolving Definitions Of Translational Research, Hana A. Alhumud, Fars K. Alanazi, Edward B. Devol

Saudi Medical Journal

Objective: To synthesize current evidence on the evolution, frameworks, and methodological approaches used to define and operationalize translational research, which serves as a bridge between scientific discovery and its application in clinical medicine, public health, and policy.
Methods: We systematically searched PubMed, Scopus, and Web of Science for peer-reviewed studies published up to 2023. Search terms combined translational research–related keywords (such as ``bench-to-bedside,'' ``implementation science,'' ``precision medicine'') and relevant MeSH terms. Eligible studies focused on conceptual models, frameworks, or methodological approaches related to translational research and were published in English. After duplicate removal and PRISMA-guided screening, 33 publications were included. …

Pharmacist-Led Initiative To Increase Naloxone Prescribing For Patients On High-Dose Opioids In A General Internal Medicine Clinic, Christine E. Leduc, Hyun J. Lee, Polly D. Fraga

The Lahey Journal

Abstract

Introduction:

Opioid overdose is a pressing public health concern in the United States. In 2022, prescription opioids were involved in 15% of all opioid deaths.1 Despite CDC recommendations for prescribing naloxone to high-risk patients, primary care physicians prescribe only 1.5 naloxone prescriptions per 100 prescriptions of high-dose opioids.2,3 Strategies are needed for healthcare institutions to expand naloxone access and mitigate opioid-related harm. This pilot study assesses the impact of a pharmacist-led quality improvement patient outreach initiative on increasing naloxone prescribing for adult patients taking ≥ 50 MME per day of prescription opioids as recommended by current CDC guidelines.

Methods: …

Strengthening Health System-Community Partnerships To Address Pediatric Social Needs: A Qualitative Study, Joy Friedman, Melissa A. Alderfer, Kelsey Higgins, Aaron Carpenter, Jennifer Sciolla, Sarah E. Wawrzynski

Department of Pediatrics Faculty Papers

IntroductionStructural and social conditions influence pediatric health outcomes. Successful implementation of social needs screening and referral programs depends on community-based organizations (CBOs) to provide resources that address health-related social needs (HRSN). We explored current practices and perspectives of health care workers and CBO representatives on improving health system-CBO partnerships.MethodsParticipants were purposively recruited from a variety of health care settings involved in HRSN screening and CBOs delivering resources in the community. Participants completed semi-structured interviews. Qualitative thematic analysis was used to summarize data.ResultsTen key informants participated (six health care workers and four CBO representatives). Four themes were identified: 1) mismatches in …

Intravascular Immune Cell Labeling As A Critical Methodological Tool For Characterizing Cd4+ T Cells In The Lung In Eae, Gholamreza Azizi, Mohamad Rostami

Department of Neurology Faculty Papers

INTRODUCTION: Growing evidence highlights the lung -brain axis as a key contributor to CNS autoimmunity. However, accurate characterization of lung immune cells remains technically challenging because standard transcardial perfusion does not eliminate the lung's extensive marginated intravascular leukocyte pool, allowing circulating cells to contaminate analyses of the lung parenchyma.

METHODS: Experimental autoimmune encephalomyelitis (EAE) was induced in mice by immunization with MOG35-55 peptide in complete Freund's adjuvant, followed by pertussis toxin administration. Lung mononuclear cells were isolated after intravascular (IV) CD45 labeling, transcardial perfusion, and enzymatic digestion. Immune cell populations and intracellular cytokine production were analyzed by multicolor flow cytometry …

Medetomidine As A Fentanyl Adulterant: Pharmacology, Detection, Clinical Presentation, And Management, Kory S. London, Phil Durney, Brendan Hart, Ashish Thakrar, Dennis Goodstein, Alex J. Krotulski, Daniel Teixeira Da Silva, Joseph D’Orazio, Lara Weinstein, Jeanmarie Perrone, Michael J. Lynch

Division of Internal Medicine Faculty Papers & Presentations

Purpose of Review Medetomidine is a veterinary α2-adrenergic agonist that has been an adulterant of illicitly manufactured opioids since 2022. We review its pharmacology, detection, intoxication, withdrawal, and management, and assess why severe withdrawal has emerged in some regions but not others. Recent Findings Medetomidine has spread through North American drug markets yet evades most toxicology testing. Roughly two hundred times more potent than xylazine, with greater α2 selectivity and imidazoline-1 activity, it causes intoxication resembling other α2 agonists: sedation and bradycardia. The dominant clinical problem is withdrawal: autonomic dysregulation, intractable vomiting, and encephalopathy frequently requiring intensive care. Treatment requires …