Digital Commons Network^™

Micro- And Nanoplastics: A Paradigm Shift In The Pathogenesis Of Inflammatory Bowel Disease, Michael Saadeh, Priyata Dutta, Gordon Hong, Edward Oldfield, David A. Johnson

Department of Medicine Faculty Publications

Micro- and nanoplastics (MNPs) are pervasive environmental contaminants with growing recognition as potential contributors to human disease. Widespread human exposure occurs primarily through ingestion of contaminated food and water, and MNPs have been detected in multiple human tissues, including the gastrointestinal tract. Experimental evidence provides a plausible biological basis for disease associations, including impairment of intestinal barrier integrity, activation of mucosal immune pathways, and alteration of gut microbial communities caused by MNP exposure. Although human data remain limited, early studies demonstrate MNP detection in stool and suggest potential correlations with inflammatory biomarkers such as fecal calprotectin. These findings, together with …

Glucagon-Like Peptide Receptor Agonists (Glp-1ras) As Cardiovascular Risk Modifiers In Obstructive Sleep Apnea And Obesity: A Real-World Study, Jaeun Ahn, Junmin Song, Kyle Admire, Yu Chang, Kuan-Yu Chi, Nathaniel T. Gordon, Joshua M. Sill

Department of Medicine Faculty Publications

Introduction

Obstructive sleep apnea (OSA) is a well-established risk factor for cardiovascular disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated potential in reducing cardiovascular risk and improving OSA severity. However, a significant knowledge gap remains regarding the impact of GLP-1RAs on cardiovascular events in OSA patients.

Methods

We examined patients with a BMI over 30 diagnosed with OSA between January 2010 and November 2021 without a previous diagnosis of heart failure, pulmonary hypertension, or myocardial infarction. Two cohorts were created: those prescribed GLP-1RAs within 1 year of their OSA diagnosis and patients who were never prescribed GLP-1RAs. Propensity score matching …

International Myositis Assessment And Clinical Studies Guidelines For Risk-Based Cancer Screening: An External Validation In Patients With Dermatomyositis Seen At A Metropolitan Academic Center, Isabel Silva, Jasper Dayanan, Alexandra Nigro, Capriana Jiang, Ma Georgina Erfe, Trixie Rivera, Saakshi Khattri

Department of Medicine Faculty Publications

Objective

Dermatomyositis (DM) is an idiopathic inflammatory myopathy (IIM) characterized by muscle weakness, skin findings, and increased malignancy risk. Cancer risk is greatest in the three years before or after DM onset, termed paraneoplastic DM. The International Myositis Assessment and Clinical Studies Group (IMACS) set forth evidence-based guidelines for risk stratification and cancer screenings for newly diagnosed patients with IIM. '

Methods

We retrospectively reviewed the records of 413 patients with a known diagnosis of DM or clinically amyopathic DM at the Mount Sinai Health System (2019-2024). Demographics, clinical findings, laboratory results, myositis autoantibody panels, and cancer screening or diagnosis …

Association Of Valvular Disease Progression Using Echocardiographic Findings In A Large U.S. Cohort, Abes A. Bautista Neughebauer, Amin Yehya, Raymond L. Benza, Deepak Talreja

Department of Medicine Faculty Publications

Background

The prevalence of valvular disease in the US is approximately 2.5%. Given that over 5 million Americans are affected, it is crucial to find those at higher risk of progression. The goal of this paper is to uncover which patients are more likely to have valvular disease progression using demographic factors, EKG and echocardiogram (ECHO) findings.

Methods

This paper utilized the EchoNext Database, which pairs 100,000 electrocardiograms and echocardiograms based on specific structural heart disease labels. Univariate and multivariate logistic regression were used to find risk factors for progression for aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), …

Regional Pain Is Associated With Functional Performance In People With Parkinson's Disease, Ryan P. Duncan, Monica R. Hendricksen, Luke Ekdahl, Kevin Smaller, Benjamin Friedman, Miriam R. Rafferty

Department of Medicine Faculty Publications

Background and Purpose:

Little is known about how pain influences physical function in people with mild Parkinson disease (PwPD). The purpose of this study was to investigate the association between physical function and pain presence, location, and intensity in PwPD who were evaluated in an early physical therapy program.

Methods:

Retrospective cross-sectional analysis of electronic medical records from patients with PD evaluated at a single center (2016-2023). Pain presence, location, and intensity (0-10 scale) were recorded at the initial physical therapy evaluation. Functional outcomes included 5-time sit-to-stand, 10-meter walk test, 6-minute walk test, timed up and go, mini-BESTest, and Functional …

Baseline Lymphopenia Predicts Survival In Ici-Naïve Solid Tumor Patients Receiving Immune Checkpoint Inhibitors: A Propensity-Matched Real-World Pan-Cancer Analysis, Ahmed Ismail, Nina Balanchivadze, George R. Simon, Yanis Boumber

Department of Medicine Faculty Publications

Background: Baseline lymphopenia is common among advanced solid tumors and may influence the efficacy/safety of immune checkpoint inhibitors (ICIs), but large real-world evidence is limited. We evaluated the association between baseline absolute lymphocyte count (ALC) and clinical outcomes in adults with solid tumors treated with ICIs in routine practice. Methods: We performed a retrospective cohort study using TriNetX. Adults with solid tumors who received pembrolizumab, nivolumab, or atezolizumab (ICI-Naïve) between January 2015 and June 2026 were included. Baseline ALC was measured within 30 days before first treatment and was classified as lymphopenic (ALC < 1.5 × 10⁹/L) or non-lymphopenic (ALC ≥ 1.5 × 10⁹/L). Propensity score matching (1:1) yielded 5249 patients per group. The index date was the first immunotherapy date, and outcomes were assessed at 6, 12, 24, 36 months, and 5 years. The primary outcome was 24-month overall survival (OS); secondary outcomes were OS at 6 and 12 months and 6-month risks of healthcare utilization, immune-related adverse events (irAEs), and serious infections; and exploratory outcomes included OS at 36 months and 5 years. All outcomes were analyzed using Kaplan–Meier analysis, Cox proportional hazards models, and risk ratios. Subgroup analysis included OS stratified by solid tumor subtypes and prior lines of therapy. Results: After matching, patients with baseline lymphopenia …

Educational Case: Hidradenitis Suppurativa, Ryan C. Saal, Linnea Lackstrom Westerkam, Cristo A. Carrasco Mendoza, Paul B. George, Christopher J. Sayed

Department of Medicine Faculty Publications

[Introduction] The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see https://doi.org/10.1016/j.acpath.2023.100086.1¹

Objective SK1.1: Pathophysiology of changes in the skin. Describe the pathophysiologic basis for changes in the color, surface texture, swelling, temperature, and sensitivity of skin.

Competency 2: Organ system pathology, Topic: Skin (SK); Learning Goal 1: …

Transatrial Balloon-Expandable Valve Implantation For Severe Mitral Annular Calcification With Native Leaflet Sealing, Omar Saleh, Rishab Agarwal, Israa Saleh, Nicholas Valle, Joshua Dolsen, Raymond L. Benza, Deepak R. Talreja, Clinton D. Kemp, Matthew R. Summers, Christopher M. Sciortino

Department of Medicine Faculty Publications

Background: Severe mitral annular calcification (MAC) limits mitral intervention options. Transseptal valve-in-MAC (ViMAC) transcatheter mitral valve replacement (TMVR) risks neo-left ventricular outflow tract (neo-LVOT) obstruction and paravalvular leak, while surgical replacement requires extensive annular reconstruction.

Case Summary: We report 3 high-risk patients with severe MAC (computed tomography [CT]-based MAC scores 7-10) who underwent open transatrial valve-in-MAC TMVR via a balloon-expandable valve after CT-based simulation and multidisciplinary heart review identified increased risk of valve malapposition or neo-LVOT obstruction precluding transseptal approach. Native anterior mitral leaflet tissue was preserved, everted, and fixed to the bioprosthetic valve cuff, creating a seal to address …

Balloon Aortic Valvuloplasty As A Bridge Therapy In Acute Valve Syndrome: A Narrative Review Of Evidence Gaps And Future Directions, Omar Saleh, Omar Jafar, Nicholas Valle, Shirish Yasa, Saleh Mostafa, Raymond L. Benza, Deepak R. Talreja, Benjamin D. Peterson, Matthew R. Summers

Department of Medicine Faculty Publications

Acute valve syndrome (AVS) represents a high-acuity, decompensated presentation of severe aortic stenosis (AS), often manifesting as acute heart failure, cardiogenic shock, or cardiac arrest. Transcatheter aortic valve replacement (TAVR) remains the only durable therapy for severe AS in patients with prohibitive surgical risk, yet AVS patients may be too unstable for standard preprocedural planning. Balloon aortic valvuloplasty (BAV) has re-emerged as a bridge strategy that can provide rapid hemodynamic stabilization and permit subsequent valve replacement. Registry analyses report lower mortality in emergent TAVR compared with BAV, but these comparisons are confounded by procedural indication and unmatched AS severity. Smaller …

Microplastics, Nanoplastics, And Obesity: Current Evidence And Biological Mechanisms, Maram Albandak, Sanam Rabeeah, Ahmad Mahdi Zahidi, David A. Johnson

Department of Medicine Faculty Publications

Obesity is a rapidly growing global health concern. The pathogenesis is complex and cannot be fully explained by lifestyle factors alone. The increasing attention towards this concern has finally been directed towards environmental contributors which may influence metabolic regulation. Microplastics and nano-plastics (MNPs) are ubiquitous environmental pollutants that have recently been detected in food, drinking water, air, and human biological samples, raising concerns about their potential role in metabolic disorders, including obesity. Chronic exposure to MNPs may interfere with metabolic homeostasis through multiple biological pathways. Emerging evidence, including both experimental and animal studies, reports alterations in lipid metabolism, body weight, …

Determinants Of Patient Satisfaction In An Academic Primary Care Setting: A Cross-Sectional Study Of The Postpandemic Era, Alvin Maliakal, Rajita Kanapareddy, Zooha Altaf, Janani Anbazhagan, Kristin Olson, Cynthia Avila, Rehan Qayyum

Department of Medicine Faculty Publications

Background

Patient satisfaction, a key indicator of healthcare quality, is associated with improved adherence, continuity, and outcomes. However, limited evidence describes determinants of patient satisfaction in contemporary primary care settings reflecting the postpandemic era, when care delivery models and patient expectations have evolved substantially.

Objective

To evaluate the sociodemographic and clinical factors associated with patient satisfaction in an academic primary care setting following the postpandemic era.

Methods

We conducted a cross-sectional survey of adult patients (≥18 years) attending a primary care clinic. Participants completed a self-administered questionnaire including the Visit-Specific Satisfaction Questionnaire (VSQ-9) and measures of sociodemographic and clinical characteristics. …

T-Cells May Represent A Novel Biomarker For Female Pattern Hair Loss, Juan Marrero Berrios, Iain Noel Encarnacion, Noelle Desir, Aman Prasad, Matthew Hedberg, Susan Taylor, John T. Seykora

Department of Medicine Faculty Publications

[Introduction] Androgenetic alopecia (AGA) is a common non-scarring alopecia classically attributed to androgen sensitivity and genetics. Histopathologic studies have identified perifollicular and perivascular lymphocytic and histiocytic infiltrates, through the composition and clinical relevance of this infiltrate have not been fully characterized.¹ Our study aims to address this gap through detailed quantitative immunohistochemical characterization (IHC) of the inflammatory infiltrate in female patients with AGA compared to telogen effluvium (TE), a non-inflammatory control.

Missed Opportunities For Stroke Prevention In Patients With Hypertension: A Retrospective Case-Control Study, Huanhuan Yang, Yuntian Liu, Chungsoo Kim, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcfadden, Mark Anderson, John S. Burrows, Harlan M. Krumholz, John E. Brush Jr., Yuan Lu

Department of Medicine Faculty Publications

Background

Hypertension is the leading modifiable risk factor for ischemic stroke, yet the adequacy of preventative hypertension care in routine clinical practice remains suboptimal, potentially representing missed opportunities for stroke prevention. We evaluated the association between hypertension care delivery and incident ischemic stroke.

Methods

 We conducted a retrospective, matched, nested case-control study among adults with hypertension using data from a large regional health system (2010-2024). Patients with a first-ever ischemic stroke were matched 1:2 to controls on age, sex, race and ethnicity, and calendar time. Three care metrics were assessed: (1) outpatient visits with blood pressure measurement per year; (2) …

Drug-Induced Lichen Planus Associated With Ocrelizumab, Avery Seward, John D. Strickley, Jeffrey P. Callen

Department of Medicine Faculty Publications

This case report highlights recurrent cutaneous lichen planus as a rare adverse effect of ocrelizumab, with flares occurring after each infusion and improving with prophylactic prednisone. Recognizing this association may help clinicians diagnose and manage similar cases while allowing patients to continue an otherwise effective therapy.

Seeds Of Sovereignty: Critical Public Health, Radical Sisterhood, And The Fight For Agricultural Justice, Andrew L. Carter

Faculty Research, Scholarly, and Creative Activity

This book explores the historical and contemporary influence of African, Caribbean, and Black (ACB) women farmers in the fight for food justice. ACB foodways have been dismantled over time due to centuries of settler colonialism, discriminatory agricultural policies, land and knowledge theft, cultural erasure, and direct forms of violence and intimidation—creating vast inequities in today’s food system. At the same time, mainstream public health responses to food insecurity and access in ACB communities often focus on short-term solutions that do not empower local communities and keep the status quo intact. These approaches overlook the broader structural constraints that maintain and …

Examining Knowledge And Comfort Levels Of Nursing Students In Providing Sexual Health Education, Deanna M. Gower

Master's Theses and Doctoral Dissertations

Sex education has been a part of the education in the United States for over 100 years. Nursing education is focused on educating nursing students in a comprehensive fashion that develops a safe and competent nurse. Due to the substantial scope of content required in nursing programs, sexual health topics can be pushed aside. This may result in gaps in sexual health knowledge and comfort for nursing students as they may be inadequately prepared to competently address patients’ sexual health needs in clinical practice. The purpose of this cross-sectional descriptive study is to examine nursing students knowledge and comfort levels …

Proactive Safety Reasoning In Human-Robot Collaboration In Disassembly Through Llm-Augmented Stpa And Fmea, Morteza Jalali Alenjareghi, Fardin Ghorbani, Samira Keivanpour, Yuvin Adnarain Chinniah, Sabrina Jocelyn

Études primaires

Disassembly tasks in human–robot collaboration (HRC) environments present safety challenges due to hazardous materials, control system variability, and physically demanding operator tasks. To address these challenges, we propose an AI-augmented risk assessment framework integrating System-Theoretic Process Analysis (STPA) and Failure Mode and Effects Analysis (FMEA). This framework is implemented in four configurations: Term Frequency– Inverse Document Frequency (TF-IDF), Fine-tuned Large Language Models (LLMs), Retrieval-Augmented Generation (RAG), and RAG with a structured Knowledge Graph (KG) built from safety standards. The system supports real-time, standards-compliant safety reasoning by generating interpretable, context-specific recommendations. We evaluate these configurations across GPT-3.5 TURBO, GPT-4o, GPT-4.1, and …

Advancing Greenhouse Air Filtration: Biodegradable Nanofiber Filters With Sustained Antimicrobial Performance, Amirali Bajgholi, Reza Jafari, Alireza Saidi

Études primaires

Air quality management in greenhouses is critical to safeguarding plant health and occupational safety, yet conventional filtration methods often fall short in performance and sustainability. These enclosed environments are prone to the accumulation of bioaerosols, including fungi, bacteria, pollen, and dust particles, which can compromise crop productivity and pose health risks to workers. This review explores recent advancements in air filtration technologies for controlled environments such as greenhouses, where airborne particulate matter, bioaerosols, and volatile organic compounds (VOCs) present ongoing challenges. Special focus is given to the development of filtration media based on electrospun nanofibers, which offer high surface area, …

Understanding Real Work Situations To Determine Sprayer Design Occupational And Environmental Health Criteria: A Mixed Methods Study Protocol, Caroline Jolly, Anouk Aubert-Simard, Damien Burlet-Vienney, Nancy Beauregard, Isabelle Feillou, Stéphane Godbout, Marion Albert

Études primaires

Background

Canada’s agricultural sector included 189,874 farms in 2021, 15% of which were located in the province of Quebec. Farmers are exposed to a variety of hazards that can lead to acute or chronic health effects, particularly when it comes to pesticide use. Machinery is often implicated in occupational injury statistics. Studies point to shortcomings in the design of crop protection sprayers, impacting not only the health and safety of workers, but also the environment. Tree sprays are currently designed and manufactured outside Quebec in accordance with regulatory requirements developed in a context where occupational health and safety (OHS) criteria …

Analysis Of The Functional And Acoustical Comfort Of Earplugs Experienced By A Group Of Workers In Canadian Companies And Identification Of The Influencing Variables, Bastien Poissenot-Arrigoni, Olivier Doutres, Alessia Negrini, Djamal Berbiche, Franck Sgard

Études primaires

Earplugs are essential for hearing protection in noisy workplaces, but their effectiveness depends heavily on user comfort, which influences proper and consistent use. This study explores functional and acoustical comfort experienced by 173 workers across Canadian companies, each testing different ’disposable or reusable’ earplug models over seven weeks. Comfort is assessed using detailed questionnaires covering six subdimensions: ease of insertion and removal, noise protection, impact on work, and discomfort related to internal and external noise perception. Linear mixed-effects models are applied within a triad framework encompassing person-, earplug-, and environment-related characteristics in order to identify those with a significant influence …

Early Drowsiness Detection Via Second-Order Derivative Analysis Of Heart Rate Variability: A Non-Contact Ecg Approach With Machine Learning, Fabrice Vaussenat, Abhiroop Bhattacharya, Julie Payette, Alireza Saidi, Victor Bellemin, Geordi-Gabriel Renaud-Dumoulin, Sylvain G. Cloutier, Ghislain Gagnon

Études primaires

Drowsy driving contributes to roughly 20% of traffic fatalities, yet most detection systems rely on behavioral cues that appear only after impairment has set in. Here we ask whether first and second derivatives of heart rate variability (HRV) can detect pre-crash states earlier than conventional approaches. Twenty-five participants completed 49 driving simulator sessions while we recorded cardiac activity through capacitive ECG electrodes embedded in the seat backrest—a non-contact method that avoids the privacy concerns of camera-based monitoring. To prevent circular evaluation, ground truth labels were based solely on crash proximity rather than HRV-derived scores. The combined HRV feature set (conventional …

Managing Complexity: Manager-Stakeholder Communication, Relational Dynamics, And The Dual Nature Of Rtw Communication, H. Bertolini, Marc Corbière, Alessia Negrini, Nadine Larivière, Patrizia Villotti, Dominic Prévost, Meryl Caiada, Jason Amorim, Fergal O'Hagan

Études primaires

Purpose

The return to work (RTW) process of worker absent due to common mental disorders (CMD) or musculoskeletal disorders (MSD) represents a complex challenge that involves multiple stakeholders. The aim of this study was to examine how managers perceive the factors that facilitate or hinder communication with other stakeholders during the RTW process.

This qualitative study was based on four focus groups conducted in Canada (Quebec and Ontario) with 18 managers.

Thematic analysis identified five themes related to facilitators and seven themes related to communication obstacles. Among the main facilitators, trust, clarity, and collaboration emerged as key elements …

Le Parcours Des Travailleurs Immigrants Blessés Et Son Incidence Sur L’Alliance Thérapeutique : Une Étude De Cas Longitudinale En Contexte De Réadaptation Au Travail Au Québec, Maude Arsenault, Jessica Dubé, Daniel Côté

Études primaires

Cette étude explore l’incidence du parcours prélésionnel des travailleuses et travailleurs immigrants (TI) blessés sur l’alliance thérapeutique (AT) en réadaptation au travail. À partir d’une ethnographie longitudinale menée dans une clinique québécoise, sept trajectoires ont été analysées selon leurs dimensions migratoires, socioprofessionnelles et linguistiques. Les résultats montrent que le déclassement professionnel, la précarité de l’emploi, les barrières linguistiques et les expériences de racisme fragilisent la construction du lien de confiance et la définition partagée des objectifs de retour au travail. Lorsque l’emploi prélésionnel est perçu comme transitoire ou inadéquat, l’obligation institutionnelle d’y retourner crée une rupture symbolique qui entre en …

If Only Pickups And Vans Could Fly: Vehicle Maintenance And The Challenge Of Safely Lifting Large Vehicles On A Two-Post Lift, Damien Burlet-Vienney, Sylvie Beaugrand, Maud Gonella, Bertrand Galy, Élise Ledoux

Études primaires

The use of automotive lifts requires mechanics to work under or near a multi-ton load. Based on consultation with stakeholders, pickups and vans appear to pose problems when raised using two-post above-ground lifts (2PAG lifts), the most common type of automotive lift in garages. The aim of this study is therefore to highlight the work activity performed by mechanics when raising pickups and vans on 2PAG lifts and to describe the factors they take into account to ensure vehicle stability. Data collection took place under actual conditions in five garages. A total of 108 lifting situations were filmed and analyzed, …

Computer Vision-Based Collision Prevention In Construction: Bridging Academic Advances And Industrial Requirements, Marwa Ziadia, François Gauthier, Damien Burlet-Vienney

Études primaires

Computer vision (CV) technologies have emerged as promising tools for real-time collision risk management. This paper examines CV-based collision-prevention systems from academic and industrial perspectives with a focus on identifying technical and implementation challenges affecting their deployment on construction sites. A scoping review of 158 publications was conducted, alongside an assessment of commercial CV-based collision-prevention systems currently used in construction. The analysis focused on five key functions: object detection, distance measurement and proximity estimation, tracking, worker re-identification (ReID), and deployment robustness. Academic studies demonstrate substantial progress in detection accuracy, real-time processing, trajectory tracking, and predictive risk assessment through deep learning …

2027 4-H National Conference Application, Kristen Landau, Kristen Lyons

UNH Cooperative Extension

No abstract provided.

The Seeds Of Peace And Justice, Shai Dothan

Chicago Journal of International Law

Some positive developments in international law had humble beginnings. They started from a small group of idealists who wanted to change the world for the better. Once their ideas gathered momentum, they got the support of people with power and transformed the world. State after state followed each other in a cascade toward improving international law. The purpose of this paper is to investigate the conditions that are beneficial for the initial germination of ideas with the potential to positively revolutionize international law. By using a series of case studies focused on the initiation of major transformations that improved international …

Climate Change As A Security Interest: A Novel Defense In Fossil Fuel Investment Arbitration, Nabil Kapasi

Chicago Journal of International Law

Thousands of international investment and trade agreements contain provisions protecting investments made by parties from the signatory states. One such provision is Investor-State Dispute Settlement (ISDS), a mechanism allowing foreign investors to sue host states in arbitration for treaty violations. Fossil fuel investors are increasingly utilizing ISDS successfully to hold states liable for climate action; arbitral tribunals are awarding large compensations to these investors when states deny them permits for upstream activities or enact phase-out policies attempting to ban fossil fuel consumption. These awards impose heavy burdens on states while simultaneously deterring climate action by creating fears of liability. This …

Evaluating The Relationship Between Motor Symptoms And Levodopa Dosage In Parkinson’S Disease, Frank Ferrari

Master's Theses and Doctoral Dissertations

Parkinson’s disease (PD) has a clear lack of dosing guidelines or standard treatment protocols, leaving physicians to develop individualized treatment plans to handle the needs of PD patients. The long-term progressive nature of Parkinson’s requires consistent care and updates to medication regimens. This puts significant strain on the healthcare systems tasked with treating them. With an increasing number of Parkinson’s patients and a plateau of professionals to care for them, patients may soon experience decreased physician availability, longer wait times, and worse quality of life outcomes. This study evaluated the relationship between PD motor symptoms, measured through the MDS-UPDRS Part …

The Ideological Work Of Penal Reform: How Reformers Justify Penal-Welfare Hybridization, John Halushka, Brandon Miller

Faculty Research, Scholarly, and Creative Activity

This article uses the Santa Clara County Reentry Resource Center (RRC) as a case study to explore the cultural content of penal reform. Specifically, we explore the discourses that officials use to publicly justify projects of penal-welfare hybridization, or the linking of state systems of punishment and welfare to manage criminalized populations. Our qualitative analysis draws on a dataset consisting of county planning documents, budgets, videos, press releases, and newsletters published online between 2011 and 2023. By examining these materials over time, we are able to chart patterns of consistency and variation in how officials justify hybridization. We find that …