Digital Commons Network^™

Ai In Adipose Imaging: Revolutionizing Visceral Adipose Tissue, Ectopic Fat, And Cardiovascular Risk Assessment, Sneha R. Kandi, Sanjay Rajagopalan, Ian J. Neeland

Faculty Scholarship

Purpose of Review: This review explores the role of artificial intelligence (AI) in visceral adipose tissue (VAT) and ectopic fat imaging. It aims to evaluate how AI may be used to enhance the efficiency and accuracy of cardiovascular disease (CVD) risk assessment. It addresses key questions regarding AI’s capabilities in risk prediction, segmentation, and integration with large volume data for CVD risk assessment. Recent Findings: Recent studies demonstrate that AI, powered by deep learning models, significantly improve VAT and ectopic fat segmentation. AI can also be used to facilitate early detection of cardiometabolic risks and allows integration of imaging with …

Taxes And Tournaments, Alex Raskolnikov

Faculty Scholarship

What is the best way to reduce economic inequality? Economists, lawyers, political philosophers, and politicians have pondered this question for decades. Yet there is another group of savvy and highly motivated individuals who have been thinking about redistribution for just as long. Commissioners of the National Football League, the National Basketball Association, the National Hockey League, and Major League Baseball, together with team owners and player unions, have been inventing and reinventing ways to redistribute resources, and they continue to do so today. The same is true of the President of National Collegiate Athletic Association, along with the heads of …

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) …

Premenopausal Transition In Neurodivergent Women With Musculoskeletal Syndromes: Mechanisms, Risks, And Neuroinclusive Therapeutics, Piper Hutson, James Hutson

Faculty Scholarship

Neurodivergent women with chronic musculoskeletal syndromes experience disproportionate premenopausal symptom burdens that are poorly characterized in extant clinical paradigms and practice. The compounded interplay of estrogen fluctuations in premenopause with sensory–executive differences and baseline nociception from joint or connective-tissue pathology yields intensified pain, mood dysregulation, and functional decline. Evidence indicates estrogen modulates nociception, neuroinflammation, bone remodeling, and monoaminergic signaling; premenopausal variability magnifies pain, affective lability, and cognitive drift—effects accentuated in autism and ADHD. Coexisting hypermobility, fibromyalgia, or connective-tissue disorders compromise joint integrity and proprioception, increasing susceptibility to estrogen-dependent changes in bone microarchitecture and tendon homeostasis. This article advances an integrative …

Stakeholder Views On Lessons Learned For The Antimicrobial Resistance Panel From Previous International Science Panels [Version 1], Iruka N. Okeke, Ayodele A. Akinyele, Javier Guzman, Kevin Outterson

Faculty Scholarship

The United Nations General Assembly called in September 2024 for the establishment of an independent panel for actionable evidence against antimicrobial resistance (IPEA). The task of designing the panel was given to the Quadripartite Joint Secretariat (QJS) on Antimicrobial Resistance (AMR) with a delivery timeline of 15 months. To promote stakeholder thought and input around what this panel should look like and how it should work, which could feed into the QJS’s consultation process, we independently commissioned seven papers to examine lessons that could be learned from other high-level scientific panels. We then called a convening of stakeholders that were …

Harnessing The Electronic Health Record To Identify And Enroll People With Epilepsy Into A Self-Management Program: Implementation And Scalability In A Clinical Setting, Clara Adeniyi, Richard Barigye, Jessica Black, Nicole Fiorelli, Carrie Rogers, Martha Sajatovic

Faculty Scholarship

Rationale: “Self-management for people with epilepsy and a history of negative health events” (SMART) is an 8-week, remotely delivered, Epilepsy Self-Management (ESM) program. The ongoing EXPANDing self-management support in healthcare networks (EXPAND) initiative leveraged the Electronic Health Record (EHR) to identify SMART candidates, simplify recruitment, and reduce staff workload. Methods: This is an ongoing implementation effort at two Level 4 Epilepsy Centers (Iowa and Cincinnati) using the Epic EHR which follows 9326 People With Epilepsy (PWE). The EHR uses pre-visit screening to identify PWE with a recent seizure; barriers to medication adherence; depression symptoms; age 18–25; or residence in rural …

Planetary Health: At The Crossroads Of Cvd Prevention, Tasveer Khawaja, Sanjay Rajagopalan

Faculty Scholarship

Purpose of Review: To highlight important recent findings demonstrating the interconnectedness of planetary and human health with a focus on cardiovascular disease. Recent Findings: Data continue to demonstrate a clear interconnectedness between the health of the planet and human health, with cardiovascular disease as an important outcome. The central roles of air pollution, non-optimal temperatures, water/waste management, and food/biodiversity are highlighted. We also highlight the clear opportunity for healthcare organizations to facilitate change that will yield positive environmental and patient outcomes. Summary: The undeniable interconnectedness of the health of the planet and human health serves as a call to action …

Complex Factors Impacting Smoking Behavior In Cancer Survivors With Food Insecurity, Madeline C. Castele, Kareena Shah, Avianna Thompson, Jin E. Kim-Mozeleski

Faculty Scholarship

Objectives: Tobacco use remains prevalent among people with social needs, such as food insecurity. In this study, we aimed to understand the complex experiences of low-income cancer survivors with food insecurity who smoke tobacco, to identify the unique smoking cessation needs for this group. Methods: We conducted in-depth, semi-structured qualitative interviews with 40 adults experiencing food insecurity who continued smoking after a cancer diagnosis. Interviews focused on smoking behaviors, cessation interest, cancer experiences, and financial circumstances. We analyzed the data using reflexive thematic analysis. Results: In this sample of cancer survivors (50% female, mean age 42 years, 60% black/African American, …

State-Level Immigrant Policies And Diabetes Prevalence In Latino And Asian American Groups: A Weighted Multilevel Analysis, Md Towfiqul Alam, Jennifer Toller Erausquin, Erica Payton, Elizabeth Vásquez, Sandra Echeverria

Faculty Scholarship

Introduction: Growing literature has shown that immigrant-related policies influence population health by limiting or enhancing immigrants’ rights. However, less is known about the role of state-level immigrant policies shaping chronic health conditions such as type 2 diabetes (T2DM). This cross-sectional study examined the association between state-level immigrant policies (both criminalising and inclusive) and prevalence of T2DM among individuals of Latin American and Asian American origin.

Method: We included adults aged 18+years sampled in the 2014–2018 behavioral risk factor surveillance system (BRFSS) (n=201 824), a survey design that allows the calculation of state-level estimates. Using existing policy measures, states …

Self-Management For People With Epilepsy And A History Of Negative Health Events (Smart): A Randomized Controlled Effectiveness Trial, Martha Sajatovic, Jessica Black, Jacqueline Krehel-Montgomery, Richard Barigye, Joy Yala, Clara Adeniyi

Faculty Scholarship

Objectives: This 2-site, 6-month randomized controlled trial of an epilepsy self-management (ESM) curriculum (SMART) vs. 6-month waitlist (WL) control assessed effects on epilepsy outcomes in 160 people with epilepsy (PWE). Methods: PWE had at least 1 negative health event (NHE) defined as a seizure, emergency department visit, hospitalization or self-harm attempt in the last 6 months. Primary outcomes were differences in proportions of PWE with reductions in NHEs from baseline to 6 months follow up and change in NHE/seizure counts between SMART and WL. Secondary outcomes included the Patient Health Questionnaire (PHQ-9), 36-Item Short Form Survey (SF-36), Quality of Life …

Current Standards And Future Directions Of Duchenne Muscular Dystrophy Respiratory Care: The Ppmd Italy Meeting Report, David J. Birnkrant, Jane Black

Faculty Scholarship

Objective: This report summarizes key discussions from the meeting “Current Standards and Future Directions of Respiratory Assessment and Management of Duchenne Muscular Dystrophy (DMD),” organized by Parent Project Muscular Dystrophy (PPMD) Italy and the United States to address current challenges and opportunities in DMD respiratory care. Methods: The meeting brought together researchers, clinicians, and patient advocates who shared experiences, discussed advancements in DMD respiratory management, and identified areas of debate that require further research. Results: The speakers emphasized routine assessment of pulmonary function and of breathing during sleep to achieve timely diagnosis of respiratory complications. Therapeutic discussions focused on airway …

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 …

A Novel Approach To Competency-Based Education For Pediatric Nurse Practitioners: Bringing Clarity To Competencies, Kristina L. Banks, Carol L. Savrin

Faculty Scholarship

Introduction: Guidance for Pediatric Nurse Practitioner (PNP) competency-based education (CBE) is provided by the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (“Essentials”). The 2021 AACN Essentials update prompted a significant shift from traditional to (CBE)for Nurse Practitioner (NP) faculty. NONPF has responded, updating its NP Role Core Competencies and domains to be congruent with the AACN 2021 Essentials, but NONPF's population-specific competencies remain unchanged since 2013. Methods: Two PNP faculty conducted a multistep crosswalk between the NONPF 2013 population-based competencies for Primary and …

Current Standards And Future Directions Of Duchenne Muscular Dystrophy Respiratory Care: The Ppmd Italy Meeting Report, Jane Black, David J. Birnkrant

Faculty Scholarship

Objective: This report summarizes key discussions from the meeting “Current Standards and Future Directions of Respiratory Assessment and Management of Duchenne Muscular Dystrophy (DMD),” organized by Parent Project Muscular Dystrophy (PPMD) Italy and the United States to address current challenges and opportunities in DMD respiratory care. Methods: The meeting brought together researchers, clinicians, and patient advocates who shared experiences, discussed advancements in DMD respiratory management, and identified areas of debate that require further research. Results: The speakers emphasized routine assessment of pulmonary function and of breathing during sleep to achieve timely diagnosis of respiratory complications. Therapeutic discussions focused on airway …

The Right To Grow Old, Jamal Greene

Faculty Scholarship

This chapter considers the status of a constitutional “right to grow old” under the US Constitution. Understood as a “positive” right – ensuring a certain minimum quality of life to people as they face the challenges of aging – such a right may seem unavailing given the austerity in respect to such rights that many lawyers associate with the US constitutional tradition. This chapter shows this view to be premature, at least. Unlike the kinds of positive rights overtly rejected in prior cases, such as rights to certain forms of social welfare or to racial equality, a right to grow …

Disparities In Dysphagia Care Among Head And Neck Cancer Patients: A Retrospective Cohort Study, Gillian Michaelson, Claudia I. Cabrera, Alexis Nahra, Nina W. Zhao

Faculty Scholarship

Objective: To investigate the incidence of dysphagia among head and neck cancer (HNC) patients and assess disparities in utilization of speech-language pathology (SLP) services across different demographic groups. Study Design: Retrospective cohort study. Setting: Analysis of data from the TriNetX global health network, comprising over 125 million deidentified electronic health records worldwide. Methods: HNC patients diagnosed with oral, oropharyngeal, laryngeal, or nasopharyngeal cancer with and without dysphagia between January 1, 2004 and October 30, 2024 were identified. Patients were divided into two cohorts for comparison: those who received SLP services after dysphagia diagnosis and those who did not. The association …

Creatine Supplementation Is Safe, Beneficial Throughout The Lifespan, And Should Not Be Restricted, Richard Kreider, Andrew Jagim, Jose Antonio, Douglas Kalman, Chad Kerksick, Jeffrey R. Stout, Robert Wildman, Rick Collins, Diego A. Bonilla

Faculty Scholarship

As researchers investigating creatine supplementation, we have become increasingly concerned about reports that government agencies are attempting to restrict the sale of dietary supplements, including dietary supplements containing creatine, to children and adolescents. Creatine is a naturally occurring compound found in every cell in the human body that plays a critical role in cellular metabolism. The daily turnover of creatine is about 2–4 grams/day, depending on muscle mass and physical activity levels (1, 2). About half of the daily need for creatine is synthesized in the body from amino acids (arginine, glycine, methionine) and stored as free creatine or phosphocreatine …

Micro-Costs, Kiel Brennan-Marquez, Brendan S. Maher

Faculty Scholarship

The modern world is filled with tiny attentional impositions (cognitiveasks) that inflict small mental burdens (micro-costs) on virtually everyone, everywhere, all the time. Micro-costs make life worse, and everybody knows it. They sap collective energy; they lead to worse decisions; they exacerbate inequality; and they contribute to an overall sense of "mismanagement" in the world, a sentiment that readily pairs with destructive political impulses.

Yet the law has essentially ignored micro-costs-until now. In what follows, we construct a theory of micro-costs that gives the phenomenon analytic shape and charts a path forward for reform. Drawing on the insights of philosophy, …

Development Of A Self-Management Tool For Individuals With Seizure Clusters: Trial Design And Methodological Report, Molly Mcvoy, Eytan Hirsch, Luisa Londono, Kari Colón-Zimmermann, Jin Seok Cho, Martha Sajatovic

Faculty Scholarship

Background: Despite advances in anti-seizure medications (ASMs) for people with epilepsy (PWE), adverse outcomes, negative health events (NHEs), and breakthrough seizures remain common. Rescue medication (RM) can better manage repetitive seizures, but barriers to RM use persist. Self-management for PWE and a history of NHEs (SMART) is an evidence-based epilepsy self-management program aimed at reducing barriers and maximizing facilitators to self-care in high-risk PWE. Methods: This 2-phase, ongoing clinical trial adapts SMART to integrate RM support for PWE with repetitive seizures. Phase 1, now completed, used input from an advisory board (AB) of PWE, caregivers, and clinicians to adapt the …

The Importance Of Better Natural History Studies For Duchenne Muscular Dystrophy, David J. Birnkrant

Faculty Scholarship

No abstract provided.

Pirfenidone Delivery By Blow-Molded Pcl Nanofiber Mat To Reduce Collagen Synthesis By Fibroblasts, Maximilian Zernic, Maryo Kohen, Faruk H. Orge, Amel Ahmed, Ozan Akkus

Faculty Scholarship

Elevated intraocular pressure (IOP) during glaucoma is sometimes mitigated by insertion of glaucoma drainage devices (GDD). Excessive fibrosis around GDD plates may confine drainage and requiring revision surgeries in some patients. Pirfenidone (PFD) is an FDA approved drug to treat lung fibrosis, and it may be effective in limiting capsule formation around the GDD. To enable this, we aimed to develop a polymeric GDD encasement sheath that can sustainably release PFD to reduce fibrous capsule formation. The PFD-doped sheath was manufactured by blow molding of (poly)caprolactone (PCL). We investigated the effects of PCL concentration, spray distance, and molecular weight on …

Development Of A Self-Management Tool For Individuals With Seizure Clusters: Trial Design And Methodological Report, Molly Mcvoy, Eytan Hirsch, Luisa Londono, Kari Colón-Zimmermann, Jin Seok Cho, Evelyn K. Shih, Martha Sajatovic

Faculty Scholarship

Background: Despite advances in anti-seizure medications (ASMs) for people with epilepsy (PWE), adverse outcomes, negative health events (NHEs), and breakthrough seizures remain common. Rescue medication (RM) can better manage repetitive seizures, but barriers to RM use persist. Self-management for PWE and a history of NHEs (SMART) is an evidence-based epilepsy self-management program aimed at reducing barriers and maximizing facilitators to self-care in high-risk PWE. Methods: This 2-phase, ongoing clinical trial adapts SMART to integrate RM support for PWE with repetitive seizures. Phase 1, now completed, used input from an advisory board (AB) of PWE, caregivers, and clinicians to adapt the …

International Society Of Sports Nutrition Position Stand: Nutrition And Weight Cut Strategies For Mixed Martial Arts And Other Combat Sports, Anthony A. Ricci, Cassandra Evans, Charles Stull, Corey A. Peacock, Duncan N. French, Jeffrey R. Stout, David H. Fukuda, Paul La Bounty, Douglas Kalman, Andrew J. Galpin, Jaime Tartar, Sarah Johnson, Richard B. Kreider, Chad Kerksick, Bill I. Campbell, Aaron Jeffery, Chris Algieri, Jose Antonio

Faculty Scholarship

Following an extensive literature review, the International Society of Sports Nutrition (ISSN) has developed an official position on nutritional and weight cut strategies for combat sports. The type of combat sport, length of the fight camp, and time between weigh-in and competition are factors influencing nutritional and weight cut strategies. The following 16points constitute the Position Statement of the Society; the Research Committee has approved them. 1. Combat sports have differing weight categories, official weigh-in times, and competition frequencies, influencing the nutritional and weight cut strategies for training and competition. 2. As the duration of a combat match increases, >4 …

Screening And Treatment Of Iron Deficiency Among Heart Failure Patients With Impaired Ejection Fraction: The Impact Of A Pharmacist-Led Protocol, Firas Al Badarin, Feras Bader, Bassam Atallah

Faculty Scholarship

Background: Despite guideline-recommended routine screening and iron deficiency (ID) treatment among heart failure (HF) patients, these practices are often underutilized. Currently, limited data are available on the outcomes of pharmacists' programs to enhance ID screening and management. Accordingly, we sought to describe the frequency and yield of screening for ID and intravenous (IV) iron replacement rates among our cohort of HF patients and examined the impact of implementing a pharmacist-led protocol (PLP) aimed at enhancing these rates. Methods: We conducted a retrospective study involving HF patients with left ventricular ejection fraction (LVEF) <45% at a quaternary care hospital in the Middle East/Gulf region. The PLP was introduced in August 2022. Data on demographics, comorbidities, echocardiographic parameters, laboratory findings (including ID screening and its findings), and rates of treatment with IV iron replacement were analyzed and compared between the pre-implementation group (n = 432, October 2015–February 2020) and the post-implementation group (n = 154, August 2022–January 2023). Results: Before the PLP, 63.2% (n = 273) of eligible patients underwent ID screening, with 80.6% (n = 220) found to have ID. Following the implementation of the PLP, screening rates significantly increased to 86.4% (n = 133) (p = 0.03), with 53.4% (n = 71) diagnosed with ID. The rate of IV iron replacement in ID patients improved from 30.4% (n = 67) in the pre-PLP group to 73% (n = 52) in the post-PLP group (p < 0.001). Multivariable logistic regression identified baseline glomerular filtration rate (GFR) and hemoglobin levels as significant predictors of IV iron replacement in the pre-PLP cohort. Conclusions: Implementing a pharmacist-led protocol was significantly associated with enhancing the screening and treatment of ID in patients with HF and LVEF <45%. This study demonstrates the crucial role of pharmacists in optimizing guideline-directed therapies, which can be replicated in various healthcare settings.

Tradeoffs In The Energetic Value Of Neuromodulation In A Closed-Loop Neuromechanical System, Zhuojun Yu, Peter J. Thomas, Hillel J. Chiel

Faculty Scholarship

Rhythmic motor behaviors controlled by neuromechanical systems, consisting of central neural circuitry, biomechanics, and sensory feedback, show efficiency in energy expenditure. The biomechanical elements (e.g., muscles) are modulated by peripheral neuromodulation which may improve their strength and speed properties. However, there are relatively few studies on neuromodulatory control of muscle function and metabolic mechanical efficiency in neuromechanical systems. To investigate the role of neuromodulation on the system's mechanical efficiency, we consider a neuromuscular model of motor patterns for feeding in the marine mollusk Aplysia californica. By incorporating muscle energetics and neuromodulatory effects into the model, we demonstrate tradeoffs in the …

The Association Between County-Level Social Determinants Of Health And Cardio-Kidney-Metabolic Disease Attributed All-Cause Mortality In The Us: A Cross Sectional Analysis, Antoinette Cotton, Pedro Rvo Salerno, Salil V. Deo, Ian Neeland, Sanjay Rajagopalan, Sadeer G. Al-Kindi, Yakov E. Elgudin

Faculty Scholarship

Background: The American Heart Association recently defined cardio-kidney-metabolic (CKM) syndrome as the intersection between metabolic, renal, and cardiovascular disease. Understanding the contemporary estimates of CKM related mortality in the US is essential for developing targeted public interventions. Methods: We analyzed state-level and county-level CKM-associated all-cause mortality data (2010-2019) from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER). Median and interquartile (IQR) age-adjusted mortality rates (aaMR) per 100,000 were reported and linked with a multi-component metric for social deprivation: the Social Deprivation Index (SDI: range 0 - 100) grouped as: I: 0 – 25, II: 26 – 50, III: 51 …

Perceptions And Practices Of Imaging Personnel And Physicians Regarding The Use Of Brain Mri For Dementia Diagnosis In Uganda, Stephen E. Jones, Martha Sajatovic

Faculty Scholarship

Introduction Diagnosing dementia remains challenging in low-income settings due to limited diagnostic options and the absence of definitive biomarkers. The use of brain MRI in the diagnosis of dementia is infrequent in Uganda, and even when it is used, subtle findings like mild regional atrophy are often overlooked, despite being crucial for imaging diagnosis. Objective The purpose of this study was to explore the perceptions and practices of imaging personnel and physicians regarding the use of brain MRI as a diagnostic approach for dementia in Uganda. Methods This was an exploratory qualitative study involving radiologists, technologists, senior house officers and …

Guardianship And Its Alternatives: A Handbook On Maryland Law, Joan O'Sullivan, Ellen A. Callegary, Rebecca Hall, James F. Silver

Faculty Scholarship

No abstract provided.

Deep And Continuous Palliative Sedation Without Artificial Nutrition And Hydration: An International Review, Richard Liu, Thaddeus Pope, April Xiaoyi Xu

Faculty Scholarship

Deep and continuous palliative sedation combined with withholding or withdrawal of artificial nutrition and hydration (collectively termed “PSs̄ANH”) is a medical process regularly used in end-of-life care as a means of alleviating suffering. But PSs̄ANH is often not governed by a clear legal framework. To shed light on different approaches to regulating PSs̄ANH, this Article conducts a comparative analysis of the PSs̄ANH legality across twelve jurisdictions.

To facilitate understanding of this broad issue, we subdivided PSs̄ANH into three categories:

(1) PSs̄ANH will not hasten death (“Type 1 PSs̄ANH”),
(2) PSs̄ANH might, but is not certain to, hasten death (“Type 2 …

Universal Public Defense, Alexis Hoag-Fordjour

Faculty Scholarship

No abstract provided.