Digital Commons Network^™

Enhancing Data Compatibility In An Evolving Landscape: Medical Cannabis And Polysubstance Use Protocols In The Phenx Toolkit, Anne Buu, Johannes Thrul, Amanda Bunting, Tamara Haegerich, Wayne Huggins, Christian Hopfer, Denise Vidot, Cataia Ives, Ryan Mcneil, Sarah Zemore, Corrie Vilsaint, Elizabeth Fallon, Christine Hill, Carol Hamilton, John Kelly

Faculty, Staff and Student Publications

Introduction: With increasing legalization of medical cannabis and prevalence of polysubstance use in the United States comes the need for standard psychometrically validated measures to study these substances' health effects in the population. The PhenX (consensus measures for Phenotypes and eXposures) Toolkit (www.phenxtoolkit.org) is a freely accessible catalog of recommended measurement protocols to promote data compatibility across studies, but this extensive catalog did not include measures in these important areas.

Methods: In 2024, a PhenX Working Group of experts followed a well-established consensus process to identify and recommend measurement protocols suitable for inclusion in studies on medical cannabis and polysubstance …

An Exploratory Analysis Of The Role Of Sex In Load Carriage, Rachel E. Perez, Dustin R. Slivka, Brent C. Ruby

Graduate Student Theses, Dissertations, & Professional Papers

Axially loaded weight may impose a metabolic demand equivalent to that of fat mass (FM) during load carriage. Males (M) typically have a lower body fat percentage than females (F), resulting in metabolic demand differences during load carriage that may be mitigated by accounting for FM in pack loads. PURPOSE: To determine whether normalizing pack load to FM equalizes metabolic cost across sexes during load carriage. METHODS: Twenty-eight participants (14M, 23 ± 5 y, 1.81 ± 0.07 m, 78.7 ± 10.0 kg, 12.7 ± 5.4% body fat, VO₂peak 4.18 ± 0.54 L·min^-1; 14F, 22 ± 4 …

N Y State Dent J January 2026

The New York State Dental Journal

In the January 2026 issue, the reader will find the following feature articles:

• No Need to Travel the Road to Licensure Renewal Alone
• IPS Subperiosteal Implant for the Maxilla and Mandible
• Amyloidoma of the Palate
• Titanium Hypersensitivity as Possible Cause of Dental Implant Failures

This issue includes regular columns with regional news impacting the New York membership including editorial and perspectives columns, legal, association activities, component news, continuing education opportunities, and classifieds.

A Complete Diploid Human Genome Benchmark For Personalized Genomics, Nancy F. Hansen, Nathan Dwarshuis, Hyun Joo Ji, Arang Rhie, Hailey Loucks, Glennis A. Logsdon, Mitchell R. Vallger, Jessica M. Storer, Juhyun Kim, Eleni Adam, Nicolas Alternose, Dmitry Antipov, Mobin Asri, Sofia Barreira, Stephanie C. Bohaczuk, Andrey V. Bzikadze, Sara A. Carioscia, Andrew Carroll, Kuan-Hao Chao, Yanan Chu, Arun Das, Peter Ebert, Adam English, Mark Fleharty, Laura E. Fleming, Giulio Formenti, Andrea Guarracino, Gabrielle A. Hartley, Katharine Jenike, Jenna Kalleberg, Yu Kang, Robert King, Josipa Lipovac, Mira Mastoras, Matthew W. Mitchell, Shloka Negi, Nathan D. Olson, Keisuke K. Oshima, Luis F. Paulin, Brandon D. Pickett, David Porubsky, Jane Ranchalis, Desh Ranjan, Mikko Rautiainen, Harold Riethman, Robert D. Schnabel, Fritz J. Sedlazeck, Kishwar Shafin, Mile Sikic, Steven J. Solar, Alexander P. Sweeten, Winston Timp, Justin Wagner, Dongahn Yoo, Ying Zhou, Erik Garrison, Evan E. Eichler, Michaeel C. Schatz, Andrew B. Stergachis, Rachel J. O'Neill, Karen H. Miga, Steven L. Salzberg, Sergey Koren, Justin M. Zook, Adam M. Phillippy

School of Medical Diagnostics & Translational Sciences Publications

Human genome sequencing typically relies on mapping reads to a reference genome to call variants, but this approach introduces technical biases, excluding duplicated and structurally polymorphic regions of the genome. To overcome this, we present a telomere-to-telomere genome benchmark with near-perfect accuracy across 99.4% of the diploid HG002 genome. This benchmark adds 701.4 Mb of autosomal sequence and both sex chromosomes (216.8 Mb), which were absent from prior benchmarks. We annotated genes and repeats on both haplotypes, including 19,956 protein-coding genes on the maternal haplotype and 19,190 on the paternal haplotype, and developed new methods to measure the accuracy of …

Predicting Tilt In Esports: A Psychophysiological Approach To Understanding Player Emotional Regulation, Nathan Rhea

University of the Pacific Theses and Dissertations

Emotional regulation and stress management are important to both casual and competitive esports players. When players become dysregulated, they experience a phenomenon known as “tilt” within the gaming community, where they often lose control of their emotions and their performance declines. This study aimed to investigate whether a psychophysiological variable in heart rate variability could predict tilt in college-age esports players. Additionally, the relationship between heart rate variability and emotions predicted by the Tiltometer system with gameplay performance and winning or losing was tested.

This study used a quantitative correlational research design. Participants for this study were college-age players (N=23) …

Chromnet: A Multi-Task Learning Framework For Cross-Cell Type Prediction Of 3d Chromatin Interactions Using Epigenetic Signals, Bin Wang, Shaokai Wang, Liqing Ding, Hongdong Li, Yaohang Li, Jianxin Wang

Computer Science Faculty Publications

The 3D organization of chromatin plays a fundamental role in gene regulation, cellular function, and disease mechanisms. However, current experimental techniques, such as Hi-C, remain costly and labor-intensive, limiting their application in large-scale and disease-related studies. To address this challenge, ChromNet is presented, a multi-task learning framework that integrates epigenetic signals across diverse cell types to enable high-precision prediction of chromatin architecture. By incorporating noise perturbation and auxiliary classification tasks, ChromNet improves the identification of topologically associating domains (TADs) and cell-type-specific chromatin structures, demonstrating superior generalization performance. Notably, ChromNet accurately predicts chromatin interactions in acute myeloid leukemia (AML) samples by …

A Comprehensive Overview Of Neurophysiological Correlates Of Cognitive Impairment In Amyotrophic Lateral Sclerosis, Seyyed Bahram Borgheai, Brie E. Achorn, Alyssa H. Zisk, Sarah M. Hosni, Karl E. G. Richter, Frank S. Menniti, Yalda Shahriari

Computer Science Faculty Publications

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to the gradual loss of motor control, typically resulting in paralysis and death within 3 to 5 years of diagnosis. ALS shares neuropathological and genetic associations with fronto-temporal dementia (FTD), a neurodegenerative condition primarily impacting cognitive functions. These two conditions are increasingly viewed as manifestations of a single molecular disease process that affects distinct brain systems, impacting motor neuronal pathways in ALS and fronto-cortical functions in FTD. However, this simple dichotomy belies the complexity of these conditions. In particular, patients with primary motor ALS can also experience significant cognitive …

Sage: Spatially Aware Gene Selection And Dual-View Embedding Fusion For Domain Identification In Spatial Transcriptomics, Yi He, Yunpei Xu, Liqing Ding, Hong-Dong Li, Yaohang Li, Shaokai Wang

Computer Science Faculty Publications

Despite enabling high-resolution mapping of gene expression within tissues, spatial transcriptomics (ST) still faces challenges in accurately segmenting spatial domains due to complex tissue architecture and limitations of current methods. Most approaches rely on local spatial priors, lack gene-level interpretability, and fall short in capturing structure-discriminative genes or long-range functional relationships, limiting their ability to resolve biologically meaningful architectures. We present Spatially Aware Gene selection and dual-view Embedding fusion (SAGE), a unified and reproducible framework for domain identification in spatial transcriptomics that combines topic-driven gene selection with dual-view embedding fusion to address these gaps. SAGE integrates non-negative matrix factorization (NMF)-based …

Adaptive Self-Attention For Enhanced Segmentation Of Adult Gliomas In Multi-Modal Mri, Evan P. Savaria, Jiangwen Sun

Computer Science Faculty Publications

Every year there are an estimated 80,000–90,000 new glioma cases, highlighting the need for reliable imaging-based decision support. Although deep learning has improved tumor sub-region segmentation, many state-of-the-art models fail to fully capture complementary information across T1, T1Gd, T2, and FLAIR MRI modalities and often operate as “black boxes,” limiting physician trust when precise delineation is critical for surgical planning, radiation targeting, and treatment monitoring. To address these limitations, we propose AIMS, an Adaptive Integrated Multi-Modal Segmentation framework that maintains modality-specific feature streams and employs adaptive self-attention within a hierarchical CNN-Transformer architecture to prioritize and fuse multi-modal MRI features. We …

Attf-Gnn: An Attention-Based Multi-Omics Graph Neural Network With Modality Learning For Disease Subtyping, Sovon Chakraborty, Eleni Adam, Terry Stilwell, Harold Riethman, Desh Ranjan, Pratip Rana

Computer Science Faculty Publications

We propose AttF-GNN, an attention-based graph fusion strategy for diseases classification and subtyping. In multiomics analysis, not all types of molecular data are equally relevant for disease subtyping and considering all modalities equally may obscure discriminative signals and limit the effectiveness of predictive models by overlooking modality-specific contributions. Therefore, we design an attention-based multimodal GraphSAGE framework that can automatically emphasize the modalities providing the most relevant information for classification. At first, we have constructed three graphs using mRNA, RNA-seq and DNA methylation modalities, and train each omics with individual GraphSAGE encoders. Next, a unified intersection graph is formed using an …

Attention-Based Multi-Omics Fusion For Drug Synergy Prediction, Kusal Debnath, Pratip Rana, Preetam Ghosh

Computer Science Faculty Publications

Drug combination therapy in disease management gained popularity in the last few decades. Computational modeling of such combinations is an active area of research in the drug discovery domain. While earlier approaches solely emphasized on the structural features of participating drugs for designing synergistic models, they lack other crucial factors directly linked with drug administration - omics expressions. As differential omics expression is a downstream consequence of the administered drug combinations, utilizing such expressions while designing synergistic models promises robust and dynamic modeling. In this work, we propose SynergyLM that fuses multi-omics features with drug embeddings to build an omics-aware …

The Myopia Epidemic: Integrating Genetic, Environmental, And Epigenetic Pathways To Define A Critical Window For Intervention, Pranavika Balaji

UROP Posters

Myopia, or nearsightedness, has increased rapidly worldwide and is now a major public health concern caused by both genetic and environmental factors. Current understanding shows that too much near work, limited time spent outdoors, and prolonged screen use contribute to abnormal eye growth in individuals who may already have a genetic predisposition. At the molecular level, epigenetic changes and shifts in DNA activity, often influenced by environmental conditions, affect the signaling pathways that regulate eye development and may help explain why myopia is increasingly common among children. This paper synthesizes recent environmental, genetic, and epigenetic research to explain how these …

Determining Genes Involved In Recovery From Chemotherapy In 4t1, Emt6, And Eo771 Breast Cancer Cells, Akash Jagdeesh, Joseph Landry Ph.D.

UROP Posters

Breast cancer is one of the most common types of cancer, and often has poor prognosis. Traditional treatments for breast cancer include chemotherapy, which involves a chemical attack on all growing cells within the body. However, these treatments are not 100% effective, and patients might experience recurrence in their cancer months or years after achieving remission. Cancer cells can evade chemotherapy through five mechanisms: senescence, quiescence, cytoprotective autophagy, and apoptosis/necroptosis suppression. Prior studies have conducted CRISPR screens and experiments involving inhibition of epigenetic regulators, to alter the regulation of genes that can contribute to breast cancer chemotherapy resistance. This study …

The Limits Of Daca: Affordability- And Access-Related Barriers To Health Professions Education, Nicole Perez, Laura Hirshfield

Journal of College Access

The U.S. is currently facing a shortage of health professionals from underrepresented backgrounds. One potential pathway to decrease this shortage is through the Deferred Action for Childhood Arrivals (DACA) program, a policy that provides temporary relief from deportation for individuals who migrated to the U.S. before age 16. This study, using 15 life-history narrative interviews, investigates the experiences of Latinx young adults who were pursuing health professions education or working as health professionals. Nine of the participants were DACA recipients, while the remaining six were second-generation (i.e., children of immigrants). An iterative, inductive approach to data analysis was used to …

Sox11 Overexpression Restores Embryonic Pro-Growth Transcription In Mature Corticospinal Tract Neurons, Eliazbeth Batsel, Zimei Wang, Elizabeth Otten, Syed Roshan, Rabia Mohammad, Paula Pascual, Darby O'Shea, Jose Rosas, Pantelis Tsoulfas, Murray G. Blackmore

Biomedical Sciences Faculty Research and Publications

Neurons in the central nervous system (CNS) display a high capacity for axon growth during early development but lose this ability at a pivotal differentiation stage marked by synaptic maturation, circuit integration, and a profound shift in gene transcription. Once mature, most CNS neurons fail to reverse this transcriptional switch after axon injury, fundamentally constraining their intrinsic capacity for axon regeneration. Here, we show with single-nucleus RNA sequencing that forced expression of the transcription factor Sox11 in mature corticospinal tract (CST) neurons produces large-scale and stable changes in gene expression that are highly enriched for growth-relevant processes, and which strongly …

Occupational Exposure To Pesticides Increases The Risk Of Amyotrophyc Lateral Sclerosis: A Systematic Review And Meta-Analysis, France Labrèche, Pamela Prudhomme, Maryse Gagnon, Nicolas Dupré, Sabrina Gravel

Études primaires

Objective To systematically review the evidence on the association between occupational exposure to pesticides and the risk of amyotrophic lateral sclerosis (ALS).

Methods A systematic search, conducted in eight bibliographic databases for publications between 1990 and 2025, identified observational studies estimating the risk of ALS after occupational pesticide exposure. Study quality was assessed using the WHO Risk of Bias (RoB) assessment instrument for systematic reviews, with the ROBINS-E (RoB in non-randomised studies of exposure) tool domains of bias. Pooled risk estimates were produced using random-effects models with restricted maximum likelihood, heterogeneity was assessed with I² statistics, and meta-regressions and publication …

Tracking Vigilance While Driving: Pilot Study Of Heart Rate Variability Classification Under A Controlled Sleep-Deprivation Protocol, James Elber Duverger, Eli Moser, Philippe Boudreau, Marie Claude Ouimet, Diane B. Boivin, Alireza Saidi

Études primaires

Decreased vigilance associated with drowsiness is a major cause of motor vehicle crashes, but its physiological characterization and detection remain difficult due to behavioral and environmental confounding factors. This study presents an original experimental framework combining a highly controlled sleep-deprivation protocol, repeated driving simulations, and a machine-learning-based heart rate variability (HRV) analysis to study the physiological and behavioral changes in vigilance during a prolonged period of wakefulness while driving. Twelve healthy young adults participated in a 30-h sleep-deprivation constant routine protocol that included driving simulations every two hours, with data collection: electrocardiography (ECG), subjective ratings of drowsiness, psychomotor vigilance test, …

Effects Of Differential Stress And Mental Health On Substance Use Among College Students, Avdi S. Avdija, Arif Akgul

Sociology & Criminal Justice Faculty Publications

Substance use among college students is often seen as a coping mechanism for some students who are prone to extreme stress, depression, or anxiety. Multiple forms of stress become the leading factors that push students toward substance use. This study tests the effects of college stressors, depression, and anxiety on substance use among college students. The results are based on the data that were collected using a 101-item questionnaire administered to 302 college students at a public university in the Midwest U.S.A. Using Logistic Regression as the primary data analysis technique, the findings of this study show that social stressors …

Structural Inequities, Environmental Toxicants, And Cardiometabolic Pathways In Cardiovascular Disease: Evidence From A Nationally Representative U.S. Population, Ese F. Oghaghare

Electronic Theses & Dissertations (2024 - present)

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States and continues to disproportionately burden racial/ethnic minorities and socioeconomically disadvantaged populations. Traditional risk factors and behavioral explanations fail to fully account for these persistent disparities, motivating increased attention to intermediate biological pathways and environmental toxicant exposures through which structural inequities may become biologically embedded. This dissertation investigates how cardiometabolic biomarkers, diet quality, and exposure to persistent organic pollutants jointly contribute to cardiovascular disease risk in a nationally representative U.S. population.

Using data from the National Health and Nutrition Examination Survey (NHANES), three complementary studies were …

Specification Of Validated Groundwater Flow And Transport Models For Historical Perfluorinated Compound Dose Reconstruction, Cindy A. Arthur

Electronic Theses & Dissertations (2024 - present)

Per- and polyfluoroalkyl substance (PFAS) contamination in Hoosick Falls, New York, resulted from historical industrial activities, with groundwater transport identified as the primary pathway impacting the municipal wellfield within the Village of Hoosick Falls, whereas atmospheric deposition remains a potential source of private well contamination. This study employed two complementary methodologies to evaluate historical municipal and private well contamination: (i) groundwater flow and transport modeling of PFOA, PFOS, PFHxS, and PFNA within the village, and (ii) Geographic Information Systems (GIS)–based inverse distance weighting (IDW) interpolation of PFOA concentrations in private wells across the broader Town of Hoosick.

Groundwater modeling results …

Combating Antibiotic Resistance With Plasmid-Dependent Phages, Rhiannon T. Mariano

Electronic Theses & Dissertations (2024 - present)

The alarming rise of carbapenem-resistant bacteria poses an urgent global health threat, driven in large part by the horizontal spread of carbapenemase-encoding plasmids (Ma et al., 2023). These plasmids are often highly mobile and transmissible, enabling rapid dissemination of resistance genes across diverse bacterial populations. Their mobility is largely mediated by conjugation, a process dependent on the formation of pili, which serve as physical bridges for plasmid transfer between cells (Murray et al. 2022; San Millan and MacLean 2017; Virolle et al. 2020). Beyond their role in gene exchange, these pili also act as entry points for a unique class …

Genomic Determinants Of Appetite Regulation And Their Role In Obesity Risk, Timothy J. Renier

Dartmouth College Ph.D Dissertations

Over 40% of US adults and 20% of children live with obesity. It is related to increased risks of diseases including type II diabetes and cancer, is a source of harmful stigma, and impairs child development. Appetitive traits describing patterns of food approach and avoidance behaviors may serve as windows into the underlying pathophysiology of obesity. As both obesity and appetitive traits are heritable, common genetic drivers of obesity may lead to phenotypic obesity through appetitive traits as a disease mechanism. Additionally, GLP-1 receptor agonists (GLP-1RAs) have been shown to exert their profound clinical effects in part by modulating appetite. …

Fgf19 As A Colorectal Cancer Serum Biomarker And Fgfr4 As A Mediator Of Anti-Her2 Resistance In Breast Cancer, Jordan Beardsley

Graduate Studies Theses and Dissertations 2026

The fibroblast growth factor 19 (FGF19)-fibroblast growth factor receptor 4 (FGFR4) signaling pathway regulates hepatic metabolism, bile acid (BA) synthesis, and hepatocyte proliferation. This signaling axis also is implicated in promoting tumor progression, therapeutic resistance, and metastasis in certain cancers.

In colorectal cancer (CRC) there is a critical need for non-invasive biomarkers for disease detection and monitoring. We identified FGF19 as a candidate CRC serum marker through meta-transcriptomics and found FGF19 to be expressed and secreted by CRC cell lines. Tumor-derived FGF19 was detectable in mouse serum at levels correlating with tumor volume in a subcutaneous xenograft model. RNA sequencing …

Pioglitazone Uncouples Macrophage Inflammatory Signaling From Epithelial Oxidative Stress During Map Infection Mimicking Crohn’S Disease Treatment, Sabera Akter Bushra

Graduate Studies Theses and Dissertations 2026

Crohn’s disease (CD) is a chronic inflammatory bowel disease characterized by intestinal inflammation, epithelial barrier dysfunction, and abnormal immune signaling. CD pathophysiology is increasingly linked to Mycobacterium avium subspecies paratuberculosis (MAP) infection, which increases chronic macrophage activation and the production of inflammatory mediators that lead to epithelial damage. Among these mediators, CXCL10, TNF-α, and IL-6 contribute in inflammation, while NOX-1 and SERPINE-1 indicate epithelial oxidative stress and damage. Despite the role of macrophage-epithelial interaction in CD, selective pharmaceutical regulation of this axis remains unclear. Pioglitazone, an FDA-approved PPARγ agonist used for type 2 diabetes, is an appealing repurposing candidate, given …

Homoplasy Of Maxillary Orthognathism In Derived Homo, Jared Jordan

Graduate Studies Theses and Dissertations 2026

The evolution of the orthognathic condition in the genus Homo represents a monumental transition toward the facial morphology of modern humans from that of earlier hominins, but the phylogenetic positioning of this transformation remains poorly understood. This study investigated temporal trends in maxillary and mandibular prognathism in the genus Homo, and whether maxillary and mandibular shortening in East Asian H. erectus and later East Asian Middle Pleistocene Homo (e.g., Homo longi) represent independent derivations of orthognathic morphology, thereby making orthognathism a homoplasy in the genus Homo. Using a sample of roughly 109 cranial and mandibular specimens spanning …

The Structure, Dynamics, And Impact Of An Interbacterial Weapon Encoded By Human Gut Bacteria, Casey John Latario

Dartmouth College Ph.D Dissertations

The human gut is densely colonized by diverse bacteria. Over a human’s growth, the GI tract becomes a dynamic community that is subjected to a continual in-flow of nutrients and would-be colonizers and an out-flow of microbes and waste products. Despite these dynamics, the bacterial community often displays stability, with particular strains persisting over decades. These stable colonizers have evolved mechanisms to bolster their colonization, resist disruption by other microbes, and persist through environmental flux.

Both interbacterial competition and horizontal gene transfer (HGT) contribute to colonization and survival within the GI tract. A major mechanism for interbacterial competition is the …

Lung Inflammation From Daily Exposure To Airborne Particulate Matter In A Trade School, Kynda Tinawi, Céline Plante, Alan Da Silveira Fleck, Édith Giasson, Isabelle Valois, Caroline Couture, Eva Suarthana, Maximilien Debia, Audrey Smargiassi

Études primaires

Background Workers are exposed daily to various airborne chemical agents, however, associations between daily exposures to particulate matter and lung inflammation in occupational settings have been little explored. Objective To estimate the association between daily occupational exposure to respirable (PM4 and PM2.5), ultrafine particles, their oxidative potential, and fractional exhaled nitric oxide within apprentices in a school of construction trades. Methods We used a repeated measures design over 5 consecutive days in 56 apprentices from 3 construction trade sectors (bricklaying, welding, and carpentry). Fractional exhaled nitric oxide was measured each day post-work. Personal and work area daily PM4 were collected …

Infection Control Across Clinical And Laboratory Dental Settings Protocols, Risks, And The Role Of Emerging Technologies, Khrystyna Vyprynyuk, Laura Andreesku

Publications and Research

This article explores infection prevention strategies and disease transmission pathways in dental settings, emphasizing the critical connection between clinical practice and dental laboratories. It highlights the risks of cross-contamination, disinfection and sterilization challenges, and the growing role of technology in enhancing infection control.

Exploring Healthcare Students' Perceptions About Race And Privilege At A Large Academic Medical Center: A Pilot Study Of A Peer Education Program, Elizabeth A. Brown, Dante Pelzer, Katrina Black Reed, Chinieka Jackman-Rogers, Madison Kimmell

Health Behavior, Policy & Management Faculty Publications

Amid the racial unrest stemming from the summer of 2020, in the United States, many institutions had difficult conversations about race and the impact of racism with employees, students, and patients. In January 2021 and February 2021, we recruited undergraduate students for the Peer Education Program (PEP), a voluntary program conducted at a large academic medical center, and encouraged students to have a safe space to discuss controversial topics in healthcare. From April 2021 to July 2021 four interdisciplinary healthcare students met once a month for 1 hr to discuss privilege, race/racism, leadership, and advocacy and their influence on health …

Prenatal Exposure To Nicotine And Postpartum Depression: A Systematic Review And Meta-Analysis, Reem Sharaf-Alddin, May Salama, Denise Mckinney, George Saade, Qi Zhang

Health Behavior, Policy & Management Faculty Publications

Purpose: Postpartum Depression (PPD) is the most common mental health complication of childbirth, and has short-term and long-term consequences for mother, child, and the entire family. PPD is a function of several factors. Prenatal exposure to nicotine (PEN) by Active Tobacco Smoking (ATS), Secondhand Smoking (SHS), or Electronic Nicotine Products (ENPs) is a major potential risk factor. This systematic review and meta-analysis aim to summarize and evaluate all evidence regarding the association between PEN and PPD.

Methods: We searched the following databases, PubMed, Medline, Cochrane, EMBASE, and CINHAL, for studies published between Jan.1st ,2000&Sep.19th ,2024, with the outcome PPD. Studies …