Digital Commons Network^™

Impact Of A Multi-Strain L. Crispatus-Based Vaginal Synbiotic On The Vaginal Microbiome: A Randomized Placebo-Controlled Trial, Jacques Ravel, Sheri Simmons, Eleni Greenwood Jaswa, Sara Gottfried, Miriam Greene, Susan Kellogg-Spadt, Dirk Gevers, Diane M. Harper

Institute of Emerging Health Professions Faculty Papers

A clinical trial of a multi-strain vaginal synbiotic (NCT05659745, registered 12/19/2022 at clinicaltrials.gov) led to an optimal vaginal microbiome dominated by L. crispatus (CST I). The synbiotic led to a significant increase in L. crispatus compared to placebo (p <  0.05), and conversion to CST I was significantly higher with the vaginal synbiotic than with placebo (90 vs 11%; p <  0.002). Mechanistically, the synbiotic reduced Gardnerella vaginalis and Candida, clinically important microbes.

Stability Of Micrornas In Serum And Plasma Reveal Promise As A Circulating Biomarker, Erryk S. Katayama, Jonathan J. Hue, Alexander W. Loftus, Semmer A. Ali, Hallie J. Graor, Luke D. Rothermel, Eric R. Londin, Mehrdad Zarei, Jordan M. Winter

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

PURPOSE: To verify the stability and reliability of circulating microRNA (miRNA) profiles in plasma and serum under different processing and storage conditions to inform future applications to circulating biomarker analyses.

BACKGROUND: The development of blood-based methods for early disease detection has become increasingly desirable across various medical fields. RNA profiles have been investigated but have been a challenge due to rapid degradation of the analyte by ubiquitous RNases. miRNAs are short, non-coding regulatory RNAs that are believed to be more stable under certain conditions, large in number, and specific to cell type and disease state. Thus, circulating miRNA profiles hold …

The Use Of A Horizontal Reference Line While Measuring The Anterior Center Edge Angle Is More Reliable Than The Traditional Method, Roland Howard, Benjamin Miltenberg, William Johns, Neel Patel, Shyam Brahmabhatt, John Salvo

Rothman Institute Papers

BACKGROUND: The anterior center edge angle (ACEA) is a radiographic parameter commonly utilized for the assessment of anterior acetabular coverage in the setting of various hip abnormalities. However, this measurement is greatly dependent on patient positioning and imaging technique.

PURPOSE: To evaluate the utility of a measurement technique utilizing a horizontal reference line and femoral head perfect circles for better control of pelvic obliquity and the assessment of its potential as a more reproducible method for determining the ACEA.

STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3.

METHODS: There were 3 authors who retrospectively reviewed the false-profile radiographs of …

Advancing Workforce Development In Digital Health: A Regional Model From The Gcc, Manal Almalki, Osama El-Hassan, Jawad Ahmed, Amr Jamal, Mowafa Househ, Evelyn Hovenga, Paul Barach

College of Population Health Faculty Papers

This study examines the evolution of ZIMAM's role in the Gulf Cooperation Council's (GCC) taskforce on workforce development in digital healthcare. Established in 2016 and formalized as a non-profit organization in 2023, ZIMAM integrates international best practices, regional insights, and innovative strategies to develop a scalable digital health knowledge and skills framework. ZIMAM's methodology includes competency mapping aligned with the Skills Framework for the Information Age (SFIA), stakeholder engagement, and iterative validation to ensure relevance and adaptability. Key ZIMAM initiatives encompass the development of governance structures, capacity-building workshops, annual conferences, and recognition programs such as the ZIMAM-ELSEVIER Digital Health Awards. …

Development Of A Health Knowledge And Skill-Based Framework For The Digital Age, Evelyn Hovenga, Osama El-Hassan, Manal Almalki, Jawad Ahmed, Paul Barach, Mowafa Househ, Amr Jamal

College of Population Health Faculty Papers

The Gulf Cooperation Council (GCC) region is tackling a significant digital healthcare workforce skills gap by creating a computable unified digital health competency framework and repository. Digital technologies and global competency standards are leveraged to professionalize the digital health knowledge domain and facilitate the development of clear career pathways in digital health. A mixed-methods approach was employed to develop the framework. A standardized categorial structure and information model has been developed to support the creation of this computable framework for workforce evaluation and competency-based career development.

First Report Of Fibropapillomatosis And Critical Habitat Use In Green Sea Turtles In Curaçao, M. Tripepi, I. J. R. Van Veghel, A. D. Vreugdenhil, E. Brunelli

College of Life Sciences Faculty Papers

Fibropapillomatosis, a disease affecting green sea turtles (Chelonia mydas), has been documented in many regions of the world, including the Caribbean, but has not been scientifically reported in Curaçao until now. The present study utilized VHF telemetry in Caracas Bay, Curaçao, to track green sea turtles, both healthy and affected by fibropapillomatosis, with the objective of ascertaining their foraging locations. VHF telemetry proved to be a pivotal method for assessing habitat use in areas characterized by limited visibility and high boat traffic, conditions that present significant challenges for divers and snorkellers attempting to access the area. The results …

The Effect Of Coadministration Of D156844 And Ar42 (Rec-2282) On The Survival And Motor Phenotype Of Mice With Spinal Muscular Atrophy, Ashlee W. Harris, Rod C. Scott, Matthew E. R. Butchbach

Department of Pediatrics Faculty Papers

Spinal muscular atrophy (SMA) is characterized by degeneration of spinal motor neurons and is a leading genetic cause of pediatric death worldwide. SMA results from the loss of or pathological variant in the survival motor neuron 1 (SMN1) gene. Disease severity is dependent on the number of copies of the orthologous SMN2 gene, which is nearly identical to SMN1 except for some key nucleotide differences. As disease severity is inversely related to SMN2 copy number, most SMA therapeutics trials have focused on identifying ways to increase SMN2 expression at different levels of gene regulation. Other studies have investigated compounds which …

Discontinuation Rates And Predictors Of Medical Cannabis Cessation For Chronic Musculoskeletal Pain, Mohammad Khak, Sina Ramtin, Juliet Chung, Asif M. Ilyas, Ari Greis

Rothman Institute Papers

Medical cannabis (MC) is increasingly used as a treatment for chronic musculoskeletal pain, but there is limited data on factors influencing its discontinuation. This study aims to investigate the rates of MC discontinuation and explore factors influencing it in patients with chronic musculoskeletal pain. A retrospective analysis was conducted on 78 patients certified for medical cannabis over a 2 year period. Patient demographics, pain origin, and Global Physical Health (GPH) and Global Mental Health (GMH) scores were collected before intervention. Discontinuation rates were measured at three-month and one-year follow-up. Statistical analyses, including Fisher's Exact Test and two-sample t-tests, were performed …

Amputation Trends Among People Who Use Drugs In The Context Of Philadelphia’S Increasingly Xylazine Adulterated Drug Supply, Rose Laurano, Monika Pogorzelska-Maziarz, Traci C. Green, Sara Beachy, Kristin L. Rising, Jeffrey K. Hom, Megan K. Reed

Jefferson Center for Connected Care Faculty Papers

BACKGROUND: Xylazine-adulterated fentanyl has rapidly spread across the United States and has been increasingly detected in overdose deaths in Philadelphia, PA through medical examiner reports, clinical testing, and widescale drug checking. Xylazine use has been associated with wounds which may lead to amputation, but the extent of this outcome has not been explored.

METHODS: Utilizing the 10th revision of the International Classification of Diseases (ICD-10) codes, we conducted a de-identified retrospective analysis of data for patients identified with opioid related disorders (ICD-10 code F11) admitted to four different hospitals in Philadelphia, PA between 2018 and 2023. Exposure to xylazine use …

Immediate-Use Rescue Medication And The Epilepsy Monitoring Unit: Experiences From An Expert Panel, Evelyn K. Shih, Brin E. Freund, Michael R. Sperling, Danielle A. Becker, Proleta Datta, Sandra Dewar, Edward Faught, Tracy Glauser, R. Edward Hogan, Randa Jarrar, Andres M. Kanner, David King-Stephens, Rebecca E. Matthews, Patricia Penovich, M. Scott Perry, Eric B. Segal, Joseph Sirven, John M. Stern, James W. Wheless, Enrique Carrazana, Adrian L. Rabinowicz, William O. Tatum

Department of Neurology Faculty Papers

BACKGROUND: People with epilepsy (PWE) may experience seizure clusters, broadly defined as ≥2 seizures that occur in close proximity. In epilepsy monitoring units (EMUs), seizure clusters can spontaneously occur during long-term videoelectroencephalogram monitoring (LTVEM) or as a result of antiseizure medication dose adjustments. In this survey, we examined the experiences and practices of expert clinicians with seizure clusters in EMUs.

METHODS: A 55-item survey was sent to members of an Epilepsy Education Council who are epilepsy experts. Items described experiences, treatment practices, and negative outcomes with seizure clusters in EMUs.

RESULTS: Of the 15 experts (aged 43-77 y), 14 are …

Feasibility And Preliminary Efficacy Of A Lymphedema And Fibrosis Self-Management Program For Head And Neck Cancer Survivors: A Pilot Randomized Controlled Trial, Jie Deng, Barbara Murphy, Lucy Andersen, Erin Mcmenamin, John Lukens, Joy Cohn, Karthik Rajasekaran, Ryan Quinn, Bryan Spinelli, Alexander Lin

Department of Physical Therapy Faculty Papers

OBJECTIVES: Survivors of head and neck cancer (HNC) are at high risk for developing lymphedema and fibrosis (LEF). Once diagnosed with LEF, survivors must engage in a lifelong program of self-care to minimize long-term adverse effects. However, evidence-based LEF self-management (SM) programs are lacking. To fill this void, we developed and pilot-tested a LEF-SM program for HNC survivors.

MATERIALS AND METHODS: The LEF-SM Program was developed using the Information-Motivation-Behavioral Skills model of health behavior change as a framework. The program was pilot tested in a three-group randomized controlled trial evaluating feasibility and preliminary efficacy. Fifty-nine participants were randomized to: Usual …

Sustained Impact: Long-Term Application Of Diagnostic Uncertainty Communication Training, Danielle M. Mccarthy, Jethel Hernandez, Dimitrios Papanagnou, Kenzie A. Cameron, David H, Salzman, Andrew W. Long, Alexandra D. Franiek, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

OBJECTIVES: More than one-third of discharged emergency department (ED) patients leave without a clear diagnosis for their symptoms. In 2019-2020, we implemented a simulation-based mastery learning curriculum across two academic medical centers to train emergency medicine residents to discuss diagnostic uncertainty during ED discharge, guided by the Uncertainty Communication Checklist (UCC). We sought to assess if this cohort continues to apply skills learned and to obtain trainee insights into the most valuable checklist items.

METHODS: A survey was emailed to all 109 participants who completed the training in 2019-2020. Questions assessed how often participants currently encountered uncertainty and used the …

Updates In Contemporary Management Of Singleton Pregnancies Complicated By A Short Cervix, Moti Gulersen, Vincenzo Berghella, Eran Bornstein

Department of Obstetrics and Gynecology Faculty Papers

Singleton pregnancies complicated by a short cervical length (≤25 mm) are at significantly increased risk for spontaneous preterm birth. Several treatment strategies aimed at reducing this risk and improving perinatal outcomes have been evaluated, including vaginal progesterone, cervical cerclage, and cervical pessary. This review summarizes the latest evidence regarding the efficacy of these interventions. Vaginal progesterone and/or cervical cerclage have been identified as proven evidence-based practices for preterm birth prevention and improve neonatal outcomes. Vaginal progesterone reduces the risk of preterm birth < 35 weeks by 27% (relative risk 0.73, 95% confidence interval 0.58-0.90). Cervical cerclage has been shown to reduce the risk of preterm birth < 35 weeks by 30% (relative risk 0.70, 95% confidence interval 0.55-0.89) in patients with a short cervical length and prior preterm birth. In contrast, recent data suggest that cervical pessary should no longer be considered a management option for these patients. A continued focus on individualized, evidence-based approaches remains essential to optimizing outcomes in this high-risk population.

Associations Between Social Drivers Of Health And Breast Cancer Stage At Diagnosis Among U.S. Black Women, Mollie Barnard, Bo Qin, Marc Emerson, Etienne Holder, Matthew Dunn, Shromona Sarkar, Nuo Xu, Yutong Li, Christine Ambrosone, Elisa Bandera, Julie Palmer, Melissa Troester, Terry Hyslop

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

U.S. Black women have disproportionately high breast cancer mortality, partly due to later-stage diagnoses. We examined how social drivers of health (SDOH) relate to stage at diagnosis by analyzing data from 4,995 breast cancer survivors in the Black Women's Health Study, Carolina Breast Cancer Study, and Women's Circle of Health Studies. SDOH were self-reported and stage was ascertained from medical records. We used polytomous logistic regression to estimate odds ratios (ORs) for diagnosis at stages III/IV or II versus stage I (referent), adjusting for age, insurance status, and income. Meta-analyzed results indicated that underutilization of screening mammography (OR = 3.21, …

Maladjustment In Minority Youth From Community Network Disparities In The Covid-19 Lockdown Environment, Michael Okoronkwo, Aaron Mack, Keyana Varnado, Michael Alfred, Kevin Hardy, Amarachi Osuji, Percy Takyi, Gabriel I. Onor, Oluwatomi Akingbola, Rahn Bailey

Department of Medicine Faculty Papers

Pandemic lockdown orders resulted in closures to critical community networks. One such infrastructure was community recreation centers/parks. This infrastructure serves a critical role in building psychosocial wellness for youth. Socioeconomic minority youth face baseline disparity in center/park distribution and services. Youth recreation activity declined 50% as result of lockdown orders with corresponding decline in youth mental health status. Despite overall youth activity decline, White and high socioeconomic demographic categories were associated with greatest recreation access during the pandemic. Thus, the pandemic exacerbated preexisting disparities in recreation access for minority youth and its benefit towards adaptive development. Minority youth experienced greater …

Twelve Tips To Help Junior Faculty Review Medical Education Literature With Confidence, Abagayle Bierowski, Casey Morrone, Ridhima Ghei, Michael Pasirstein, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Peer reviews play a critical role in maintaining the quality, credibility, and advancement of medical education scholarships. While many early career faculty members are eager to contribute to the peer review process, there are few formal resources available to guide them in how to approach this work effectively. This article offers 12 practical tips tailored specifically for junior faculty who are new to reviewing medical education manuscripts. These tips cover key aspects of the review process, including how to structure feedback, evaluate methodological rigor, assess alignment with journal aims, and communicate constructively with authors and editors. The guide also emphasizes …

Comparative Outcomes Of Coil Embolization And Surgical Clipping In Elderly Patients With Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, Yohanna Idsabella Rossi, Gabriel Bolner, Jonathan Costa Dall'acqua, Fabiana Dolovitsch De Oliveira, Lucas V. Zacaria, Taís L. Denicol, Michel Frudit, Natália Vasconcellos De Oliveira Souza

Department of Neurology Faculty Papers

BACKGROUND AND OBJECTIVES: Elderly patients with subarachnoid hemorrhage (SAH) face a disproportionately high burden of morbidity and mortality. While endovascular coiling is often favored in this population, direct comparisons with surgical clipping are limited. We conducted a meta-analysis to compare outcomes of clipping versus coiling in SAH patients aged ≥ 60 years.

METHODS: A systematic search of PubMed, Embase, and Cochrane databases identified studies comparing the two treatments in this age group. The primary outcome was a composite of unfavorable outcomes (modified Rankin Scale [mRS] > 2 and mortality). Secondary outcomes included mortality, favorable outcome (mRS 0-2), rebleeding, and hospital length …

The Effect Of Hcv On Methadone Dose During Pregnancy, Sarah Boudova, Neel S. Iyer, Danielle M. Tholey, Jonathan M. Fenkel, Rupsa C. Boelig

Department of Obstetrics and Gynecology Faculty Papers

Pregnancy is a time of high patient motivation to initiate treatment for opioid use disorder (OUD). Hepatic drug metabolism can be altered by pregnancy and hepatitis C virus (HCV) infection. We aimed to examine the impact of HCV during pregnancy on methadone dosing. Retrospective chart review of all pregnant patients with OUD admitted for initiation of methadone from 1/2020-6/2022. Associations were examined using Student's T-tests, chi-squared tests, Fisher's exact tests and univariate and multivariate linear regression. We identified 191 pregnancies initiated on methadone, of which 188 were screened for HCV. 111 (59.0%) were HCV Antibody (Ab)+, of whom 108 were …

Breast Cancer Survival Rates And Determinants In Ethiopia: A Systematic Review And Meta-Analysis Of Longitudinal Studies, Abenezer M. Tafese, Meseker T. Fentie, Beminate L. Seifu, Angwach A. Asnake, Bikiltu D. Dirbaba, Abdisa G. Jara, Elsabeth Tizazu Asare, Brandon George

College of Population Health Faculty Papers

BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer mortality among women in Ethiopia, accounting for 32% of new cancer cases and 17.6% of cancer deaths. Despite its growing burden, comprehensive data on survival rates and contributing factors remain limited. This systematic review and meta-analysis aimed to synthesize existing data on breast cancer survival in Ethiopia and identify key determinants influencing outcomes.

METHODS: A comprehensive systematic search was conducted in PubMed, Web of Science, Scopus, Embase, and CINAHL to identify studies on breast cancer survival in Ethiopia published between January 2014 and August 2024. Eligible …

Evaluating Virtual Group Coaching’S Impact On Self-Determination In Spinal Cord Injury, Alana Scalzo, Ms, Otr/L

Post-Professional Occupational Therapy Doctorate Culminating Presentations

Introduction: Spinal cord injury (SCI) is a lifelong condition that requires effort and adjustment for managing physical, psychological, and social well-being to have the ability to engage in meaningful activities. As people living with SCI have higher rates of isolation and social disconnect, it is important to study group level approaches for addressing mental health.

Objectives: To determine the impact of virtual group coaching to enhance occupational performance, satisfaction, self-efficacy and relationship closeness in people living with SCI.

Methods: A quasi-experimental single-group pre/post-test design was used. Adults with SCI were recruited through online flyers, social media, newsletters, support groups, clinics, …

The Efficacy Of Virtual Group Coaching On The Self-Determination Of People With Ehlers-Danlos Syndrome, Janine E. Rajauski, Ms, Otr/L

Post-Professional Occupational Therapy Doctorate Culminating Presentations

INTRODUCTION
The Ehlers-Danlos Syndromes (EDS) are a family of 13 genetic connective tissue disorders that affect negatively physical and psychosocial health which in turns have been found to decrease their quality of life and self-determination (Baeza-Velasco et al., 2019; Bennet et al., 2021; Estrella & Fraizer, 2024; Tinkle et al., 2017; Palomo-Toucedo et al., 2020). Limited supports and services, including occupational therapy, are available for those with EDS (Estrella & Frazier, 2024; McDonald et al., 2023; Reychler et al., 2021). Those with EDS have requested better services to support their self-determination (Estrella & Frazier, 2024). Coaching has shown positive impacts …

Caregiver Attitudes Of Risky Outdoor Play For Toddlers With Developmental Delays And Disabilities In St. Louis, Missouri: A Socio-Ecological Perspective, Emily Korte-Stroff, Ot/L

Post-Professional Occupational Therapy Doctorate Culminating Presentations

Abstract: Risky outdoor play fosters autonomy, emotional regulation, and resilience in early childhood, yet caregivers of toddlers with developmental delays and disabilities often face unique barriers to supporting such play. Limited research has examined how caregivers perceive the factors shaping these decisions, particularly in the United States context. This mixed-methods cross-sectional study explored how caregivers in the St. Louis, Missouri metropolitan area perceive the socio-ecological factors shaping their attitudes toward risky outdoor play for children aged 13 to 47 months with developmental delays or disabilities. The project sought to first explore caregivers' perceptions of how interpersonal and individual factors, shape …

Quantile Index Predictors Using R Package Hyper.Gam, Tingting Zhan, Misung Yi, Inna Chervoneva

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

MOTIVATION: Evaluation of single-cell protein expression from immunohistochemistry images is used increasingly in biomedical research. Many proteins are used solely for phenotyping cells in the tumor microenvironment. Other proteins with meaningfully quantitative expression levels provide so-called functional protein biomarkers. There is still a limited number of methods and software tools available for utilizing the entire distributions of single-cell expression levels.

RESULTS: We present the R package hyper.gam, providing a supervised learning framework for deriving biomarkers based on single-cell distribution quantiles. The single-cell data are first converted into sample quantile functions, which are then used as predictors in scalar-on-function regression models …

A Word From The Writing Team (August 2025), Pam Walter, Mfa

A Word From the Writing Team (Newsletter)

This issue includes:

• Publications Spotlight
• Join the Last Summer Writing Warriors Session Tomorrow
• Check out our Fall Workshops
• Two Ways to Fund Open Access Fees

Differing Impacts Of Cardiac Implantable Electronic Device Leads On Tricuspid Regurgitation, Sophie A. Leon, Melissa Austin, Nayeem Nasher, Daler Rahimov, Faizaan Siddique, Chitra Parikh, Danial Ahmad, Vakhtang Tchantchaleishvili, Behzad B. Pavri

Division of Cardiology Faculty Papers

BACKGROUND: Placement of cardiac implantable electronic devices (CIED) with leads that traverse the tricuspid valve is thought to contribute to tricuspid regurgitation (TR). However, there are relatively limited data comparing the impact of different CIED lead types on the incidence and progression of TR. This study sought to quantify the change in TR severity following implantation of CIEDs with different lead types.

METHODS: Patient data were collected on individuals with implantable cardioverter defibrillators (ICD), right ventricular-paced pacemakers (RV-PM), and His bundle-paced pacemakers (His-PM) placed by a single provider at a single institution between 2016 and 2019. Patients with extravascular CIED …

Identifying Critical Evidence Gaps In Wound Closure And Incision Management After Total Hip Arthroplasty: Delphi Panel Insights, Margaret Ainslie-Garcia, Lucas Anderson, Benjamin Bloch, Tim N Board, Antonia Chen, Samantha Craigie, Walter Danker, Najmuddin Gunja, James Harty, Victor Hernandez, Kate Lebedeva, Mitchell Ng, Daniel Hameed, Michael Mont, Ryan Nunley, Javad Parvizi, Sean Sequeira, Carsten Perka, Nicolas Piuzzi, Ola Rolfson, Joshua Rychlik, Emilio Romanini, Pablo Sanz-Ruiz, Rafael Sierra, Linda Suleiman, Eleftherios Tsiridis, Pascal-André Vendittoli, Helge Wangen, Luigi Zagra

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: In total hip arthroplasty (THA), proper management of surgical incisions is essential for optimal wound healing and patient outcomes. Despite advances in surgical techniques, significant challenges remain in preventing complications and infections. This study aimed to identify evidence gaps in THA wound care, including presurgical preparation, intraoperative practices, and postsurgical complications.

METHODS: Using a modified Delphi method, 20 expert orthopedic surgeons from Europe and North America participated in a 3-phase consensus process from April 1 to September 30, 2023. This included a preliminary questionnaire, a remote conference, and a final online survey. The panel reviewed literature and achieved agreement …

Hospitality In Crisis: Evaluating The Downside Risks And Market Sensitivity Of Hospitality Reits, Davinder K. Malhotra, Raymond Poteau

School of Business Faculty Papers

This study evaluates the risk-adjusted performance of Hospitality REITs using multi-factor asset pricing models and downside risk measures with the aim of assessing their diversification potential and crisis sensitivity. Unlike prior studies that examine REITs in aggregate, this study isolates Hospitality REITs to explore their unique cyclical and macroeconomic sensitivities. This study looks at the risk-adjusted performance of Hospitality Real Estate Investment Trusts (REITs) in relation to more general REIT indexes and the S&P 500 Index. The study reveals that monthly returns of Hospitality REITs increasingly move in tandem with the stock markets during financial crises, which reduces their historical …

Work Impairment And Financial Outcomes Among Adults With Vs Without Long Covid, Michael Gottlieb, Ji Chen, Huihui Yu, Michelle Santangelo, Erica S. Spatz, Nicole L. Gentile, Rachel E. Geyer, Caitlin Malicki, Kristyn Gatling, Kelli N. O'Laughlin, Kari A. Stephens, Joann G. Elmore, Lauren E. Wisk, Michelle L'Hommedieu, Robert Rodriguez, Juan Carlos C. Montoy, Ralph C. Wang, Kristin L. Rising, Efrat Kean, Jonathan W. Dyal, Mandy J. Hill, Arjun K. Venkatesh, Robert A. Weinstein

Department of Emergency Medicine Faculty Papers

IMPORTANCE: While much of the focus on long COVID (LC; defined as developing new, persistent symptoms lasting 3 months or longer after SARS-CoV-2 infection) has been on health status and quality of life, the impact on individual work productivity and financial distress are less well established.

OBJECTIVES: To assess differences in work and financial outcomes among individuals with current, resolved, and no LC up to 3 years after initial infection.

DESIGN, SETTING, AND PARTICIPANTS: This prospective, multisite, longitudinal cohort study enrolled adult participants (age ≥18 years) with at least 1 reported SARS-CoV-2 infection from December 7, 2020, to August 29, …

Vascular Risk Factors And 1-Year Cognitive Change Among Individuals With Traumatic Brain Injury, Andrea L. C. Schneider, Katherine Hunzinger, Benjamin L. Brett, Danielle K Sandsmark, Sonia Jain, Xiaoying Sun, Raquel C. Gardner, Geoffrey T. Manley, Ramon Diaz-Arrastia, Lindsay D. Nelson, Patrick Belton, Shawn Eagle, Shankar Gopinath, Ramesh Grandhi, C. Dirk Keene, Vijay Krishnamoorthy, Christine Mac Donald, Michael Mccrea, Randall Merchant, Pratik Mukherjee, Laura B. Ngwenya, David Okonkwo, Claudia Robertson, David Schnyer, Sabrina R. Taylor, John K. Yue, Ross Zafonte

Department of Exercise Science Faculty Papers

IMPORTANCE: Traumatic brain injury (TBI) and vascular risk factors are associated with cognitive impairment, but it is unknown if individuals with vascular risk factors experience worse cognitive outcomes after TBI.

OBJECTIVE: To evaluate cognitive function among patients with TBI with vs without comorbid preinjury vascular risk factors.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study examined individuals with TBI enrolled in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Study between February 26, 2014, and August 8, 2018, with a 1-year follow-up. Analyses were conducted February 26, 2024, to May 29, 2025.

EXPOSURES: Vascular risk factors (ie, hypertension, diabetes, …

Chronic Cluster Headache Is A Rare Disease: Implications For Diagnosis, Treatment And Public Health, Hsiangkuo Yuan, Jan Hoffmann, Elena Ruiz De La Torre, Michael J. Marmura, Mario F. P. Peres

Department of Jefferson Headache Center Papers and Presentations

Cluster headache (CH) is a rare and painful primary headache disorder characterized by severe unilateral pain and cranial autonomic symptoms. This perspective examines the epidemiological evidence supporting the classification of chronic cluster headache (CCH) as a rare disease, noting a prevalence of CH of approximately 124 per 100,000 individuals, with only 3.5-13.7% manifesting CCH. This prevalence meets criteria established by both the US Food and Drug Administration and European Medicines Agency for rare disease designation. The rarity of CCH creates substantial clinical and research challenges, including prolonged diagnostic delays, limited research funding and a dearth of approved treatments. The economic …