Digital Commons Network^™

Putting The Lawyer First: Framing Well-Being In Law As An Ethical Dilemma, Aric Short

Faculty Scholarship

A disturbingly high percentage of our students continue to be unwell. In the most recent and comprehensive survey of law student well-being in 2021, almost 70% of law students responded that, in the past twelve months, they believed they needed to seek help for emotional or mental health problems. Embedded screening tools in the survey suggested that 34% of respondents were clinically depressed and 54% suffered from clinical anxiety. 44% of respondents reported being drunk in the past thirty days, 33% had engaged in binge drinking in the preceding two weeks, and 38% had smoked marijuana in the past twelve …

A Mouse Model Of The Protease-Activated Receptor 4 Pro310leu Variant Has Reduced Platelet Reactivity, Xu Han, Elizabeth A. Knauss, Maria De La Fuente, Ronald A. Conlon, David F. Lepage, Weihong Jiang, Marvin T. Nieman

Faculty Scholarship

Background: Protease-activated receptor 4 (PAR4) mediates thrombin signaling on platelets and other cells. Our recent structural studies demonstrated that a single nucleotide polymorphism in extracellular loop 3 and PAR4-P310L (rs2227376) leads to a hyporeactive receptor. Objectives: The goal of this study was to determine how the hyporeactive PAR4 variant in extracellular loop 3 impacts platelet function in vivo using a novel knock-in mouse model (PAR4-322L). Methods: A point mutation was introduced into the PAR4 gene F2rl3 via CRISPR/Cas9 to create PAR4-P322L, the mouse homolog to human PAR4-P310L. Platelet response to PAR4 activation peptide (AYPGKF), thrombin, ADP, and convulxin was monitored …

Present Case Studies Highlighting Practical Implications Of Architectural Design Choices, Emily Barnes, James Hutson

Faculty Scholarship

The interpretability of deep neural networks (DNNs) has become a crucial focus within artificial intelligence and machine learning, particularly as these models are increasingly used in high-stakes applications such as healthcare, finance, and autonomous driving. This article explores the impact of architectural design choices on the interpretability of DNNs, emphasizing the importance of transparency, trust, and accountability in AI systems. By presenting case studies and experimental results, the article highlights how different architectural elements—such as layer types, network depth, connectivity patterns, and attention mechanisms—affect model interpretability and performance. The discussion is structured into three main sections: real-world applications, architectural trade-offs, …

Repeated Stimulation Of Feeding Mechanoafferents In Aplysia Generates Responses Consistent With The Release Of Food, Hillel J. Chiel

Faculty Scholarship

How does repeated stimulation of mechanoafferents affect feeding motor neurons? Monosynaptic connections from a mechanoafferent population in the Aplysia buccal ganglia to five motor followers with different functions were examined during repeated stimulus trains. The mechanoafferents produced both fast and slow synaptic outputs, which could be excitatory or inhibitory. In contrast, other Aplysia mechanoafferents produce only fast excitation on their followers. In addition, patterns of synaptic connections were different to the different motor followers. Some followers received both fast excitation and fast inhibition, whereas others received exclusively fast excitation. All followers showed strong decreases in fast postsynaptic potential (PSP) amplitude …

Perspectives On The Constitution Of The War On Drugs: A Collection Of Posts From The Balkinization Blog, Douglas A. Berman, Rachel Barkow, Louis Michael Seidman, Kimani Paul-Emile, Jennifer D. Oliva, Shaun Ossei-Owusu, Katherine Shaw, Paul Butler, David E. Pozen

Faculty Scholarship

This collection of essays provides extended commentary from multiple law professors on David Pozen’s 2024 book, The Constitution of the War on Drugs. Pozen’s book provides a rich and astute perspective on a wide array of dynamic legal, political, and social stories at the intersection of constitutional jurisprudence and drug policy. The work is the first book in Oxford University Press’s Inalienable Rights series to be fully open access. Yale Law Professor Jack Balkin, recognizing the book engaged many historical and cutting-edge issues in the fields of constitutional law, criminal law and health law, invited professors in these fields …

Transforming The Welfare State, One Case At A Time: How Utrecht Makes Customized Social Care Work, Charles F. Sabel, Jonathan Zeitlin, Jan-Kees Helderman

Faculty Scholarship

Advanced welfare states are under pressure to customize services, promptly enough to prevent a cascade of harms. With these goals, the Netherlands in 2015 decentralized social care services to municipalities, and within municipalities to neighborhood teams in continuing contact with clients. The overall results have been disappointing. But the experience of Utrecht, the Netherlands’ fourth-largest city, has been strikingly different. By using hard-to-resolve cases to signal conflicts in rules, obstructive jurisdictional boundaries, and the shortcomings of private service providers, Utrecht is learning to customize and speed delivery of social care through incremental steps. This article explains how Utrecht’s success addresses …

School Nutrition Stakeholders Find Utility In Mealsim: An Agent-Based Model, Melissa Pflugh Prescott

Faculty Scholarship

Objective: To obtain feedback from school nutrition stakeholders on an agent-based model simulating school lunch to inform model refinement and future applications. Design: Qualitative study using online discussion groups. Setting: School nutrition professional stakeholders across the US. Participants: Twenty-eight school nutrition stakeholders. Phenomenon of Interest: Perceptions and applicability of MealSim for school nutrition stakeholders to help reduce food waste. Analysis: Deductive approach followed by inductive analysis of discussion group transcripts. Results: Stakeholders appreciated the customizability of the cafeteria characteristics and suggested adding additional characteristics to best represent the school meal system, such as factors relating to school staff supervision of …

A Data Integration Framework Of Additive Manufacturing Based On Fair Principles, Kristen J. Hernandez, Erika I. Barcelos, Jayvic C. Jimenez, Arafath Nihar, Pawan K. Tripathi, Roger H. French, Laura S. Bruckman

Faculty Scholarship

Abstract: Laser-powder bed fusion (L-PBF) is a popular additive manufacturing (AM) process with rich data sets coming from both in situ and ex situ sources. Data derived from multiple measurement modalities in an AM process capture unique features but often have different encoding methods; the challenge of data registration is not directly intuitive. In this work, we address the challenge of data registration between multiple modalities. Large data spaces must be organized in a machine-compatible method to maximize scientific output. FAIR (findable, accessible, interoperable, and reusable) principles are required to overcome challenges associated with data at various scales. FAIRified data …

Avidity Maturation Of Humoral Response Following Primary And Booster Doses Of Bnt162b2 Mrna Vaccine Among Nursing Home Residents And Healthcare Workers, Oladayo A. Oyebanji, Nicholas Sundheimer, Vaishnavi Ragavapuram, Brigid M. Wilson, Jürgen Bosch, Christopher L. King, David H. Canaday

Faculty Scholarship

Infections, despite vaccination, can be clinically consequential for frail nursing home residents (NHR). Poor vaccine-induced antibody quality may add risk for such subsequent infections and more severe disease. We assessed antibody binding avidity, as a surrogate for antibody quality, among NHR and healthcare workers (HCW). We longitudinally sampled 112 NHR and 52 HCWs who received the BNT162b2 mRNA vaccine after each dose up to the Wuhan-BA.4/5-based Omicron bivalent boosters. We quantified anti-spike, anti-receptor binding domain (RBD), and avidity levels to the ancestral Wuhan, Delta, and Omicron BA.1 & 4/5 strains. The primary vaccination series produced substantial anti-spike and RBD levels …

Review Of Treatment Of Hepatitis C Among Persons Who Are Housing Insecure And Use Substances, Kate Kelley

Faculty Scholarship

With the advent of direct-acting antiviral agents (DAA), reduction of hepatitis C infection (HCV) has become a public health priority. The World Health Organization’s goal of global elimination of HCV by 2030 has brought to light the challenges in treating certain populations. This review examines the burden of HCV infection on unhoused individuals and people who use substances in the United States in the last five years, and presents best practices in patient care and treatment.

Recent Findings On The Effectiveness Of Peer Support For Patients With Type 2 Diabetes, James J. Werner, Kelsey Ufholz, Prashant Yamajala

Faculty Scholarship

Purpose of Review: To review randomized controlled trials (RCTs) published from 2021–2023 that reported the effects of peer support interventions on outcomes in patients with type 2 diabetes (T2DM). Recent Findings: Literature searches yielded 137 articles and nine RCTs were ultimately reviewed. The reviewed trials involved in-person support groups, peer coach/mentor support, cultural peer support by community health workers, peer support during shared medical appointments (SMAs) including virtual reality-based SMAs, telehealth-facilitated programs, and telephone peer support. Most interventions combined two or more peer support strategies. Peer support was associated with significant decreases in HbA1c in 6 of the 9 reviewed …

Editorial: Transfusion Medicine And Blood, Volume Ii, Robert W. Maitta

Faculty Scholarship

No abstract provided.

Lay Advisor Interventions For Hypertension Outcomes: A Systematic Review, Meta-Analysis And A Re-Aim Evaluation, Sonal J. Patil, Leila Bushweller, Eno-Obong Udoh, Irina Todorov, Robert Saper, Kurt C. Stange, Shari Bolen

Faculty Scholarship

Introduction: Lay advisor interventions improve hypertension outcomes; however, the added benefits and relevant factors for their widespread implementation into health systems are unknown. We performed a systematic review to: (1) summarize the benefits of adding lay advisors to interventions on hypertension outcomes, and (2) summarize factors associated with successful implementation in health systems using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Methods: We systematically searched several databases, including Ovid MEDLINE, CINAHL, PsycINFO from January 1981 to May 2023. All study designs of interventions delivered solely by lay advisors for adults with hypertension were eligible. If both arms received the …

Continuing Benefits Of The Montreal Protocol And Protection Of The Stratospheric Ozone Layer For Human Health And The Environment, Laura S. Bruckman

Faculty Scholarship

The protection of Earth’s stratospheric ozone (O3) is an ongoing process under the auspices of the universally ratified Montreal Protocol and its Amendments and adjustments. A critical part of this process is the assessment of the environmental issues related to changes in O3. The United Nations Environment Programme’s Environmental Effects Assessment Panel provides annual scientific evaluations of some of the key issues arising in the recent collective knowledge base. This current update includes a comprehensive assessment of the incidence rates of skin cancer, cataract and other skin and eye diseases observed worldwide; the effects of UV radiation on tropospheric oxidants, …

Social Needs Screening And Intervention In Pediatric Primary Care: Impact On Families’ Experience Of Care, Sarah D. Ronis, Marie Masotya, Kurt C. Stange

Faculty Scholarship

Introduction/Objectives: Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents’ experience of their child’s medical home is associated with their perceptions of a practice-based social needs intervention. Methods: We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate …

Development Of An International Standard Set Of Outcomes And Measurement Methods For Routine Practice For Infants, Children, And Adolescents With Epilepsy: The International Consortium For Health Outcomes Measurement Consensus Recommendations, Martha Sajatovic

Faculty Scholarship

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition …

Best Anticoagulation Strategy With And Without Appendage Occlusion For Stroke-Prophylaxis In Postablation Atrial Fibrillation Patients With Cardiac Amyloidosis, Andrea Natale

Faculty Scholarship

Introduction: Both atrial fibrillation (AF) and amyloidosis increase stroke risk. We evaluated the best anticoagulation strategy in AF patients with coexistent amyloidosis. Methods: Consecutive AF patients with concomitant amyloidosis were divided into two groups based on the postablation stroke-prophylaxis approach; group 1: left atrial appendage occlusion (LAAO) in eligible patients and group 2: oral anticoagulation (OAC). Group 1 patients were further divided into Gr. 1A: LAAO + half-does NOAC (HD-NOAC) for 6 months followed by aspirin 81 mg/day and Gr. 1B: LAAO + HD-NOAC. In group 1 patients, with complete occlusion at the 45-day transesophageal echocardiogram, patients were switched to …

Violence Exposure And Trauma Screener For Youth (Vetsy), Daniel Joseph Flannery, Ivette Noriega, Mark Singer, Jeff Kretschmar

Faculty Scholarship

Background: Youth exposed to violence are at serious risk for physical, emotional, behavioral, and mental distress. Reliable and prompt detection is necessary to mitigate the psychological consequences of youth violence exposure and trauma. Objective: To describe the initial creation of the VETSY screener and its construct validity and potential use. Methods: From 2014 through 2022 we surveyed 20,532 at-risk youth aged 8–18 years from a diverse metropolitan community participating in the Defending Childhood Initiative (DCI). Youth completed a 17-item self-report screener. An Exploratory Factor Analysis (EFA) was used to determine the reliability and variable grouping for this brief screener. Violence …

Viral Meningitis And Encephalitis Update, Boris Garber, Jonathan Glauser

Faculty Scholarship

Purpose of Review: This review describes advances in the diagnosis, treatment, and prevention of non-bacterial meningitis and encephalitis, with a focus on emerging viral causes of central nervous system (CNS) infection. Recent Findings: The Infectious Diseases Society of America recently published new guidelines for the management of encephalitis. Multiple articles have been published detailing emerging etiologies in human CNS infections, including analyses of neurological complications in the ongoing COVID-19 pandemic. Finally, several novel viral detection methods have been described, which may improve the detection of the specific etiologies of CNS infections (Hongyan et al. Front Neurol 14, [1]). Summary: Meningitis …

Opening Brief For Plaintiff-Appellant Rocky Freeman, Madeline H. Meth, Sanketh Bhaskar, Henry Drembus, Brianna Jordan

Faculty Scholarship

For nearly two decades, while Rocky Freeman was in federal prison, the United States treated him like a contract killer who murdered two victims even though the U.S. Probation Office knew that this information was false, and the Bureau of Prisons (BOP) knew or should have known the same merely by looking at Freeman’s pre-sentence report (PSR). As a result, Freeman spent years subject to harsh conditions of confinement that he would not have experienced had probation or BOP officers acted with reasonable care. Since learning about this negligence, Freeman has sought repeatedly to remedy the various harms he suffered, …

Development Of An International Standard Set Of Outcomes And Measurement Methods For Routine Practice For Adults With Epilepsy: The International Consortium For Health Outcomes Measurement Consensus Recommendations, Martha Sajatovic

Faculty Scholarship

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient–clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep …

Us Neonatal Intensive Care Unit Registered Dietitian Nutritionists Salary Description And Correlates: Results Of A Survey, Rosa K. Hand, Sharon Groh-Wargo

Faculty Scholarship

Background: This survey described the compensation of neonatal intensive care unit (NICU) registered dietitian nutritionists (RDNs) in the United States and examined correlates of higher salaries within this group. Methods: A cross-sectional online survey was completed in 2021 by 143 NICU RDNs from 127 US hospitals who reported hourly wage in US dollars (USD). We used initial bivariate analyses to assess the relationship of selected institution-level and individual-level variables to hourly wage; the rank-sum test for binary variables; bivariate regression and Pearson correlation coefficients for continuous variables; the Kruskal–Wallis test for categorical variables. Variables with a compelling relationship to the …

Sexual Function After Gender Affirming Surgery, Alicia R. Castellanos, Rachel Pope

Faculty Scholarship

Purpose of Review: Sexual function and satisfaction in the transgender community is a nascent field with a paucity of data due to the fast paced nature of improving upon surgical technique and variety of patient experiences. The authors aim to review the current literature for areas of success as well as areas of improvement in order to better the sexual health of the transgender community. Recent Findings: Gender dysphoria is a feeling of distress experienced by those whose gender assigned at birth is not in line with their gender identity. While social transition to the desired gender can suffice for …

Improved Motor Skills In Autistic Children After Three Weeks Of Neurologic Music Therapy Via Telehealth: A Pilot Study, Nicole M. Richard Williams, Corene Hurt-Thaut, Jessica Brian, Luc Tremblay, Marija Pranjic, Jessica Teich, Melissa Tan, Julia Kowaleski, Michael Thaut

Faculty Scholarship

Background: Many autistic children experience motor skill deficits which can impact other areas of functioning, and research on therapeutic interventions for motor skills in autism is in a preliminary stage. Music-based therapies have been used extensively to address motor skills in non-autistic populations. Though a handful of studies exist on the effects of music-based therapies for movement in autistic children, none have investigated the possibility of administering sessions via telehealth. This mixed-methods pilot study investigated whether nine Neurologic Music Therapy (NMT)^® sessions via telehealth would improve motor and attention skills in autistic children.

Methods: Five autistic children between five …

Preferences, Risk Neutrality And Risk-Sensitive Mdps, James Alexander, Matthew J. Sobel

Faculty Scholarship

A binary preference relation on a real vector space satisfying four (natural) axioms is shown to induce a utility function composed of a linear function to the reals and a weakly monotonic function. The key axiom is decomposition, and the utility function can be taken to be linear if and only if this axiom’s converse is also satisfied. Important consequences follow for risk-sensitive discounted Markov decision processes, decision trees, and the discounted utility model in economics. Since the four axioms imply that preferences correspond to discounting, the four axioms without the converse imply that preferences are consistent with discounting without …

Comparison Of Hospital Volume And Risk-Standardized Mortality Rate As A Proxy For Hospital Quality In Complex Oncologic Hepatopancreatobiliary Surgery, William T. Julian, John B. Ammori, Jeffrey M. Hardacre, Lee M. Ocuin

Faculty Scholarship

Background: Centralization of hepatopancreatobiliary procedures to more experienced centers has been recommended but remains controversial. Hospital volume and risk-stratified mortality rates (RSMR) are metrics for interhospital comparison. We compared facility operative volume with facility RSMR as a proxy for hospital quality. Patients and Methods: Patients who underwent surgery for liver (LC), biliary tract (BTC), and pancreatic (PDAC) cancer were identified in the National Cancer Database (2004–2018). Hierarchical logistic regression was used to create facility-specific models for RSMR. Volume (high versus low) was determined by quintile. Performance (high versus low) was determined by RSMR tercile. Primary outcomes included median facility RSMR …

The Efficacy Of Telemental Health Interventions For Mood Disorders Pre-Covid-19: A Narrative Review, Alyssa M. Edwards, Jordan C. Petitt, Martha Sajatovic, Sanjana Kumar, Jennifer B. Levin

Faculty Scholarship

The onset of the COVID-19 pandemic saw a significant surge in the utilization of telemental health (TMH) services. This narrative review aimed to investigate the efficacy of TMH for serious mood disorders prior to the COVID-19 pandemic. A search across databases was conducted for randomized controlled trials focusing on TMH interventions for mood disorders, encompassing major depressive disorder (MDD) and bipolar disorder (BD). Study and patient characteristics, interventions, and outcomes were extracted. From a pool of 2611 papers initially identified, 17 met the inclusion criteria: 14 focused on MDD, while 4 addressed BD. Among these, 6 papers directly compared TMH …

The Spectrum Of Pneumonia Among Intubated Neonates In The Neonatal Intensive Care Unit, Dayle J. Bondarev, Rita M. Ryan, Devashis Mukherjee

Faculty Scholarship

We review the pathophysiology, epidemiology, diagnosis, treatment, and prevention of ventilator-associated pneumonia (VAP) in neonates. VAP has been studied primarily in adult ICU patients, although there has been more focus on pediatric and neonatal VAP (neo-VAP) in the last decade. The definition as well as diagnosis of VAP in neonates remains a challenge to date. The neonatal intensivist needs to be familiar with the current diagnostic tools and prevention strategies available to treat and reduce VAP to reduce neonatal morbidity and the emergence of antibiotic resistance. This review also highlights preventive strategies and old and emerging treatments available.

Simulacra And Historical Fidelity In Digital Recreation Of Lost Cultural Heritage: Reconstituting Period Materialities For The Period Eye, Trent Olsen, James Hutson, Charles O'Brien, Jeremiah Ratican

Faculty Scholarship

The advancement of digital technologies in art history has opened avenues for reconstructing lost or damaged cultural heritage, a need highlighted by the deteriorated state of many artworks from the 1785 Salon. Grounded in the concept of the “Period Eye” by art historian Michael Baxandall, which emphasizes understanding artworks within their original historical and cultural contexts, this study proposes a subfield focused on Reconstituting Period Materialities for the Period Eye. This methodology bridges comprehensive historical research with generative visual artificial intelligence (AI) technologies, facilitating the creation and immersive virtual reality viewing of artworks. Beyond mere visual replication, the approach aims …

Advancing Sentiment Analysis Through Emotionally-Agnostic Text Mining In Large Language Models (Llms), Jay Ratican, James Hutson

Faculty Scholarship

The conventional methodology for sentiment analysis within large language models (LLMs) has predominantly drawn upon human emotional frameworks, incorporating physiological cues that are inherently absent in text-only communication. This research proposes a paradigm shift towards an emotionallyagnostic approach to sentiment analysis in LLMs, which concentrates on purely textual expressions of sentiment, circumventing the confounding effects of human physiological responses. The aim is to refine sentiment analysis algorithms to discern and generate emotionally congruent responses strictly from text-based cues. This study presents a comprehensive framework for an emotionally-agnostic sentiment analysis model that systematically excludes physiological indicators whilst maintaining the analytical depth …