Digital Commons Network^™

Lessons Learned For The Independent Panel For Evidence For Action Against Amr From Previous International Science Panels: Stakeholder Views From The 2025 Lagos Workshop, Iruka N. Okeke, Anthony Mcdonnell, Ayodele A. Akinyele, Javier Guzman, Kevin Outterson

Faculty Scholarship

In September, 2024, the UN General Assembly assigned the Quadripartite Joint Secretariat on Antimicrobial Resistance (AMR) the task of establishing an Independent Panel for Evidence for Action against AMR (IPEA). To promote stakeholder views and input around the constitution and functioning of this Panel, which could feed into the Quadripartite Joint Secretariat’s consultation process, we independently commissioned seven papers to examine the lessons that could be learned from other high-level scientific panels. We then convened 85 stakeholders, primed with the background papers. The Workshop, held in Lagos, Nigeria in April, 2025, drew representation from around the world, particularly low-income or …

Climate Lies And Unjust Profits, Vanessa Casado-Pérez, Yotam Kaplan, Yael Lifshitz, Niv Meyerson

Faculty Scholarship

The climate crisis has reached a perilous tipping point. Our entrenched reliance on fossil fuels remains unchecked, as fossil fuel corporations wield their power to block meaningful reform and entrench their profits. The political horizon offers little relief—an incoming administration is poised to dismantle vital environmental protections, stripping away the few safeguards that stand between us and climate catastrophe.

In this grim landscape, communities across the nation are turning to the courts with renewed urgency, seeking justice and reform through climate litigation. Yet past efforts have fallen short, stymied by two formidable barriers. First, by centering on greenhouse gas emissions …

Mainstreaming Mistrust: The Shift In Us Vaccine Policy Under The Trump Administration, Sanjin Musa, Amy Estlund, Megan A. Berman

Faculty Scholarship

Department of Health and Human Services led by Robert F. Kennedy Jr., represents a significant departure from long-standing public health norms. This commentary explores how historically marginalized anti-vaccine activism has moved into the mainstream of government oversight. Key actions driving this transition include the wholesale replacement of the Advisory Committee on Immunization Practices, the departure of senior CDC officials, and the public questioning of established childhood immunization schedules. Furthermore, the administration has ceased financial support for global health entities like the World Health Organization and Gavi, the Vaccine Alliance, while canceling funding for innovative mRNA vaccine platforms. 

These domestic policy …

Transforming Blood Management Systems In Developing Countries Through Technological And Artificial Intelligence-Driven Innovations, Sandeep Bhargava, Shaun Aaron Abram, Srividhya Ragavan

Faculty Scholarship

It is critical to ensure the safe and quality supply of blood among various stakeholders; however, this remains a significant challenge in today’s world, especially in developing countries. These countries face severe problems, including blood shortages, fragmented regulatory frameworks, and inconsistent quality control measures. To tackle these challenges, countries like India are trying to implement the use of artificial intelligence (AI) and its derivative platforms to transform blood collection, testing, storage, and distribution by enabling interoperability, real-time compliance monitoring, automated donor screening, optimized inventory management, and advanced component separation. The article argues that developing countries must adopt both regulatory reform …

Priority Without Progress: The Fda's Neglected Tropical Disease Voucher Program After 18 Years, Maple Goh, Kevin Outterson, Aaron Kesselheim

Faculty Scholarship

Introduction: To incentivize drug and vaccine development for neglected tropical diseases (NTDs), US Congress created the Priority Review Voucher (PRV) program in 2007. Sponsors that obtain Food and Drug Administration (FDA) approval for an eligible product receive a voucher redeemable to accelerate review of another product.

Methods: We reviewed the program’s public health impact by examining all 14 vouchers awarded for NTD products between 2007 and 2024, including the timing of FDA approval relative to World Health Organization (WHO) Prequalification, Essential Medicines List inclusion, first use in endemic countries, and voucher disposition.

Results: Eight (57%) achieved WHO …

Health Truth To Power: Professional Collaboration To Bolster Trust Against Misinformation, William M. Sage, Keegan D. Warren

Faculty Scholarship

This Article is about health, leaving aside more general challenges to shared civic information today. The Article begins by surveying the principal challenges for health information in post-pandemic, arguably post-truth America, and then describes briefly the sources and limits of medical professional authority. Noting the double-edged sword of free speech guarantees under the U.S. Constitution, the Article continues by commenting on speaking truth to government, to industry, and to the crowd. Next, the Article considers the physicians’ role in speaking truth to power from the perspective of standard medical professional ethics and identity, comparing it to that of lawyers. Finally, …

Social Science Contributions To The Global Action Plan On Antimicrobial Resistance Management, Mathieu Poirier, Jaskeerat Singh, Isaac Weldon, Clare I. R. Chandler, Daniela Corno, Laura Valtere, Pedro Henrique D Batista, Daniel Carelli, Geneviève Boily-Larouche, Sonia Lewycka, Fiona Emdin, Kathleen Liddell, Timo Minssen, Ilaria Natali, Susan Nayiga, Iruka N. Okeke, Emmanuel Olamijuwon, Kevin Outterson, Julianne Piper, Kayla Strong, Jarnail Singh Thakur, Kednapa Thavorn, Maarten Van Der Heijden, A. M. Viens, Mary Wiktorowicz, Steven J. Hoffman

Faculty Scholarship

Social science research on antimicrobial resistance has gained traction in the last decade, employing a diverse set of theoretical perspectives to better understand topics ranging from antimicrobial stewardship to political coordination.4 As the action plan commitments will be updated in 2026, an opportunity exists to employ a broader social science scope to accelerate national antimicrobial resistance interventions.

In January 2025, the Global strategy lab convened leading antimicrobial resistance social scientists from a variety of disciplines to determine which new ways of understanding antimicrobial resistance could catalyse and incentivize action. Three conceptions stood out as important to revisions of the action …

Retrenchment, Segregation, And Public Education: A Five-Year Analysis Of State Exclusionary School Discipline Legislation, Thalia Gonzalez, Will Martel

Faculty Scholarship

Notwithstanding the decision in Brown v. Board of Education formally ending educational segregation and more than two decades of state reform, the legislative landscape protecting minoritized children from the structural violence of exclusionary school discipline has dramatically shifted in less than five years. From the passage of state “Teacher’s Bills of Rights” to mandatory expulsions, rescissions of prior protections, and new categories of removal, a retrenchment of anti-inclusion legislation—and its corollary, educational carcerality— has occurred. While studies of other forms of legislative retrenchment in K–12 public schools, such as anti-Critical Race Theory and Don’t Say Gay laws, literacy bans, and …

Opening Brief For Plaintiff-Appellant Jacob Julick, Aryssa Harris, Cameron Tong, Madeline H. Meth

Faculty Scholarship

For ten days in the middle of winter, officers at the Kentucky State Penitentiary (KSP) confined Jacob Julick in freezing cells, dressed only in paper boxers, and without access to hygiene products, a shower, cleaning products, bedding, or shoes. The reason? Mistaken retribution in response to a recent assault on an officer in which Julick was not involved.

When Julick reported experiencing suicidal thoughts, Defendant Officer Jason Denny mocked him, telling him to “kill [him]self and do them the favor.” Shortly after, Julick was moved from his first solitary cell to a strip cage where he was handcuffed, shackled, and …

Providing Spatial Support During A Major Cholera Outbreak In Port-Au-Prince, Haiti: Creative Mapping Solutions In A Challenging Data Poor Environment, Andrew Curtis, Jayakrishnan Ajayakumar

Faculty Scholarship

In this paper we describe the spatial data challenges faced in terms of providing accurate and timely analysis for a clinic during a cholera epidemic that spread through Port au Prince, Haiti in late 2022. This “triage” spatial epidemiology involved developing a bespoke geocoder that allowed for weekly maps of spread to be created in near real time. Resulting case data were also analyzed using a novel grid heatmapping approach which considers the epidemiological curve for each neighborhood. Adding further complexity during this period to both the data generation, and explaining cholera amplification and spread patterns, was a rising gang …

Whose Burden, Whose Benefit? Revisiting Ethical Trade-Offs In The Who Guidelines On Scaling Up Mass Azithromycin Administration, Maple Goh, A. M. Viens, Safura Abdool Karim, Aaron S. Kesselheim, Kevin Outterson

Faculty Scholarship

Author summary

• New evidence suggests that mass drug administration of azithromycin (MDAA) can significantly reduce childhood mortality in high-burden, low-resource settings, yet the World Health Organization’s (WHO) 2020 guidelines take a cautious approach due to concerns about antimicrobial resistance (AMR).
• While the WHO guidelines cite ethical principles, they insufficiently address key considerations, such as intergenerational justice, equitable burden sharing, and the structural determinants of health that shape infectious disease vulnerability.
• Global AMR policy often prioritizes conservation over access in ways that disproportionately burden low-income countries, despite high-income countries also bearing significant responsibility for the emergence and spread of AMR.
• A …

Differential Effects Of Macrophage Subtype-Specific Cytokines On Fibroblast Proliferation And Endothelial Cell Function In Co-Culture System, Phillip Mcclellan, Thomas R. Wong, Sara Hijaz, David R. Fletcher, Ozan Akkus, Tracey L. Bonfield, James M. Anderson, Adonis Hijaz

Faculty Scholarship

Macrophages are involved in several critical activities associated with tissue repair and regeneration. Current approaches in regenerative medicine are focusing on leveraging the innate immune response to accelerate tissue regeneration and improve long-term healing outcomes. Of particular interest in this regard are the currently known, four main M2 macrophage subtypes: M2interleukin (IL)-4,IL-13, M2IC, M2IL-10, M2non-selective adenosine receptor agonists (NECA) (M2IL-4,IL-13 → M2(NECA). In this study, rat bone marrow-derived macrophages (M₀) were polarized to each of the four subtypes M2IL-4,IL-13 → M2NECA and cultured for 72 h in vitro. Luminex assay results highlighted increased production of tissue inhibitor of metalloproteinases-1 (TIMP-1) …

Examining Pricing And Availability For Neglected Tropical Disease Therapies In The Us, Maple Goh, Kevin Outterson, Aaron S. Kesselheim

Faculty Scholarship

Background

Neglected tropical diseases primarily affect vulnerable populations in low-resource settings worldwide. In the US, neglected tropical diseases such as Chagas, soil-transmitted helminthiases, and other infections historically impacted immigrants but are increasingly relevant for US residents with climate change. We examined the pricing, prescribing rates, and supply of therapies used to treat neglected tropical diseases in the US and their implications for accessibility and patient care. Methods

A retrospective analysis of prescription rates, wholesale acquisition costs, and shortages was conducted for 11 treatment products from 2019 to 2024, aggregating data from Symphony Metys, First Databank, NAVLIN, Red Book, and the …

Unlocking Musculoskeletal Anatomy: Enhancing Second-Year Medical Students’ Knowledge Recall And Self-Efficacy With A Physician-Led Ultrasound Session, Nathan Cowan, Abdus Sattar, Qian Wu, Allison N. Schroeder

Faculty Scholarship

Introduction: The purpose of this study was to determine whether exposure to musculoskeletal (MSK) ultrasound (US) enhanced medical students’ knowledge and self-efficacy in understanding basic US principles, MSK anatomy and physical examination, and use of US to evaluate MSK structures. Materials and Methods: Forty-three second-year medical students were divided into control (n = 22) and experimental (n = 21) groups. All participants completed a pre-session self-efficacy questionnaire and were encouraged to view a recorded 20-min MSK US lecture. All participants then attended a physician-led 35-min MSK US hands-on scanning session covering the shoulder and knee. The control group took a …

Perianal Infections Update, Boris Garber, Jonathan Glauser

Faculty Scholarship

Purpose of Review We describe the evaluation, treatment, and disposition of patients presenting with perianal and rectal complaints, specifically focusing on identifying and treating various infectious diseases affecting this area. Risk factors and preventative strategies are also discussed where known. Recent Findings Several professional medical associations, namely the World Society of Emergency Surgery and the American Association for the Surgery of Trauma, recently promulgated new guidelines concerning the diagnosis and management of common infectious rectal disorders [1]. The American College of Radiology also published its criteria for choosing appropriate imaging modalities for anorectal disease [2]. Additionally, new meta-analyses have been …

Apolipoprotein E (Apoe) And Alzheimer's Disease Risk In A Ugandan Population: A Pilot Case-Control Study, Martha Sajatovic

Faculty Scholarship

Alzheimer's disease (AD) is a neurodegenerative disorder that is characterized by cognitive decline and progressive functional impairment. The Apolipoprotein E (APOE) gene, particularly its ϵ2, ϵ3, and ϵ4 alleles, plays a crucial role in lipid metabolism, and has been implicated in AD pathogenesis. Although the APOE ϵ4 status is associated with an increased risk of AD, its impact varies across populations. This study investigated the prevalence of and association between APOE alleles and AD risk in a Ugandan cohort. This case-control study was conducted in Uganda, and included 87 participants (45 patients with AD and 42 healthy controls). Cognitive assessment …

Administrative Law And The Pandemic, Gillian E. Metzger

Faculty Scholarship

American administrative law’s relationship to change is, as they say, compli­cated. On the one hand, continual evolution has been an endemic feature of American administrative law. Doctrines such as Chevron deference to agency statutory interpretations were born, grew, and declined in just the period from the 1980s to today. On the other, the United States (US) Supreme Court regularly rejects such common law development in administrative law as illegitimate and insists that federal judges must adhere to the original terms of the 1946 Administrative Procedure Act (APA) and other statutes, unless the Constitution requires otherwise. And to this day scholars …

Characterization Of The Gut Microbiome In Alzheimer Disease And Mild Cognitive Impairment Among Older Adults In Uganda: A Case-Control Study, Martha Sajatovic, Scott M. Williams

Faculty Scholarship

Alzheimer disease (AD) is associated with significant shifts in the gut microbiome and is characterized by reduced microbial diversity and changes in the abundance of specific taxa. These alterations can disrupt the gut-brain axis, leading to increased intestinal permeability ("leaky gut"), systemic inflammation, and oxidative stress. Such microbial changes are thought to contribute to neurodegenerative changes, as observed in AD and cognitive decline, thus emphasizing the role of the microbiome in aging-related neurological health. Our study in urban and rural population in Uganda recruited 104 participants aged 60 years and older, categorized into AD, mild cognitive impairment (MCI), and control …

Sustained Release Of Antifibrotic Nintedanib From Polymer Microparticles Reduces Dosing Frequency While Reducing Inflammation In Murine Idiopathic Pulmonary Fibrosis, Emmanuel Einyat Opolot, Filip Goshevski, Rahul Chaudhary, Horst A. Von Recum, Amar B. Desai

Faculty Scholarship

Purpose: Idiopathic pulmonary fibrosis (IPF) is a life-threatening, progressive lung disease with limited therapeutic options, often resulting in poor patient outcomes. Current treatments, such as Nintedanib (NTB) and Pirfenidone (PFD), require frequent administration, leading to adverse effects and low patient adherence. The purpose of this study was to investigate a sustained-release drug delivery system utilizing microparticles (MPs) composed of insoluble beta-cyclodextrin (β-CD) polymers to enhance the bioavailability and extend the release of NTB and PFD. Methods: A multidisciplinary approach, including in silico modeling, in vitro assays, and in vivo studies, was employed to assess the efficacy of β-CD-polymer MPs as …

Addressing Hiv And Substance Use Health Disparities Among Racial/Ethnic Minority Individuals, Jamie V. Saunt, David L. Hussey

Faculty Scholarship

Purpose of Review: Advances in HIV testing, prevention, and treatment, alongside increased awareness and harm reduction efforts for substance use disorder (SUD) have improved care and treatment access over the past decade. However, racial and ethnic minorities with SUD and HIV or at risk for HIV still face disproportionately high health disparities. Understanding and addressing the reasons behind these disparities is crucial. Recent Findings: Structural and systemic barriers continue to negatively impact minoritized communities, due to lack of access to care, mistrust, and feelings of ostracization. Disconnected systems for HIV and SUD treatment complicate combined care. Delays in HIV diagnosis …

Petition For Initial Hearing En Banc, United States V. Michael Norwood, Becca Steinberg, Brian Wolfman, Regina Wong, Madeline H. Meth, Sara Brizio, Elizabeth Brownstein, Shreya Sarin

Faculty Scholarship

This appeal involves a question of exceptional importance because it implicates binding circuit precedent that directly conflicts with the United States Sentencing Commission’s exercise of statutorily delegated authority. Congress expressly charged the Commission with promulgating policy statements and guidelines establishing, among other things, a framework governing compassionate release of federal prisoners. 28 U.S.C. § 994(a), (t). So, when Congress provided that district courts could consider a sentence reduction if warranted by “extraordinary and compelling reasons,” 18 U.S.C. § 3582(c)(1)(A), Congress did not define that phrase. Instead, it directed the Commission to do so. 28 U.S.C. § 994(t).

The Commission did …

Prevalence Of Social Determinants Of Health Risk Factors Among And Their Impact On Viral Suppression, Consistent Visits, And No-Show Rates Among Persons With Hiv Who Identify As Hispanic, Mary Cowden, Ana Clavijo, Pragnya Iyengar, Ann Avery

Faculty Scholarship

The current study examines the association between language preference, social determinants of health (SDOH) risk factors, viral load, and HIV care outcomes among individuals of Hispanic ethnicity in the United States. More than half (54%) of all participants reported having two or more unmet needs. Hispanic individuals were more likely to be at risk in 2 or more domains than their non-Hispanic counterparts. Food insecurity was the most common risk factor reported and when present, 51% of patients also reported financial resource strain. Surprisingly, when language preference was analyzed, English-preferring Hispanic patients were at higher risk of financial resource strain, …

Examining The Relationship Between Frailty, Operative Management, And 90-Day Mortality Across Emergency General Surgery Conditions, Caleb W. Curry, Marisa R. Imbroane, Wyatt P. Bensken, Adam T. Perzynski, Christopher W. Towe, Vanessa P. Ho

Faculty Scholarship

No abstract provided.

Aging Is Associated With Decreased Lactobacillus And Increased Cervicovaginal Inflammation In Canadian Women, Ha T. Dang, Laura Noel-Romas, Samantha Knodel, Kenzie Birse, Hossaena Ayele, Alicia R. Berard, Adam D. Burgener, Christina Farr Zuend

Faculty Scholarship

Problem: Aging is characterized by a general dysregulation of systemic immune responses that increases susceptibility to infections and malignancies. Immune cells in the female genital tract (FGT) are regulated by sex hormones, but little is known about the impact of aging and menopause on immunology in the FGT. Method of Study: This study conducted an age-focused sub-analysis of cervicovaginal samples collected from 47 women enrolled in the Vaginal Mucosal Systems study in Winnipeg, Canada. Paired cervicovaginal lavage and cervical cytobrush were collected and analyzed by Luminex cytokine array, mass spectrometry based metaproteomics, metabolomics, and high dimensional flow cytometry. Results: The …

Thrombocytopenia In Sepsis, Alireza Setarehaseman, Robert W. Maitta

Faculty Scholarship

Platelets, traditionally known for their role in hemostasis, have emerged as key players in immune response and inflammation. Sepsis, a life-threatening condition characterized by systemic inflammation, often presents with thrombocytopenia, which at times, can be significant. Platelets contribute to the inflammatory response by interacting with leukocytes, endothelial cells, and the innate immune system. However, excessive platelet activation and consumption can lead to thrombocytopenia and exacerbate the severity of sepsis. Understanding the multifaceted roles of platelets in sepsis is crucial for developing effective therapeutic strategies. Targeting platelet-mediated inflammatory responses and promoting platelet production may offer potential avenues for improving outcomes in …

Expanding Health Insurance For Formerly Incarcerated People, Benjamin Barsky, James R. Jolin, Meredith B. Rosenthal

Faculty Scholarship

No abstract provided.

The United States Healthcare System: From Medicare To Post-Pandemic Health Policy, William M. Sage

Faculty Scholarship

My purpose in this essay is to comment on national health policy in the United States over the past sixty years.  My conclusions are less optimistic than what I had hoped when I began my teaching and research career in the 1990s to be able to say in 2025.  In particular, the successful expansion of publicly supported health coverage via the passage of the Affordable Care Act (“ACA” or “Obamacare”) in 2010 seems to have triggered -- though I hesitate to say that it caused – a backsliding from broader commitments to clinical performance, population health, and social solidarity that …

Feasibility Of A Low-Intensity Intervention To Influence Antibiotic Prescribing Rates Use In Outpatient Settings: A Cluster Randomized Controlled Clinical Trial, Brigid M. Wilson, Sunah Song, Robin L.P. Jump, Federico Perez

Faculty Scholarship

Background. Primary care providers (PCPs) may modify their antibiotic prescription practices if aware of their potentially damaging impact. Methods. We conducted a cluster randomized controlled trial at 12 Veterans Affairs community-based outpatient clinics. PCPs at clinics randomized to the intervention group received quarterly antibiotic use reports with feedback about antibiotics prescribed for acute respiratory infections and adverse event letters alerting about Clostridioides difficile infection or antibiotic-resistant gram-negative bacteria among their patients. The main outcome, antibiotic prescriptions in primary care visits, was compared in the preintervention (April–September 2020), intervention (October 2020 to September 2021), and postintervention periods (September 2021 to September …

Intellectual Property, Innovation And Economic Inequality, Daniel Benoliel, Peter K. Yu, Francis Gurry, Keun Lee

Faculty Scholarship

While growing disparities in wealth and income are well-documented across the globe, the role of intellectual property rights is often overlooked. This volume brings together leading commentators from around the world to interrogate the interrelationship between intellectual property and economic inequality. Interdisciplinary and globally oriented by design, the book features economists, legal scholars, policy analysts, and other experts. Chapters address the impact of intellectual property rights on economic inequality, the effect of economic inequality on the protection and enforcement of these rights, and the potential use of innovation law and policy to help reduce economic inequality. The volume also tackles …

Introduction To Intellectual Property, Innovation And Economic Inequality, Daniel Benoliel, Peter K. Yu

Faculty Scholarship

This chapter provides an introduction to Intellectual Property, Innovation and Economic Inequality. It begins by discussing the problem of economic inequality, including the scale of that problem, types of economic inequality, and extant research on such inequality. The chapter then outlines the structure of this volume, which is divided into three parts: (1) theoretical, empirical, and policy issues; (2) intellectual property and national inequality; and (3) intellectual property and global inequality.