Digital Commons Network^™

Clinical And Demographic Characteristics Of Hospitalized Patients With Xylazine-Related Wounds, Elizabeth Novick, Nikhil Seval, Dagan Coppock, Mollie Tucker, Daniel Taupin, John Zurlo, Carolyn Kramer

Department of Medicine Faculty Papers

OBJECTIVES: Little is known about the demographic and clinical features of patients with xylazine-related wounds. We sought to characterize hospitalized patients with substance use disorder (SUD) and xylazine-related wounds seen for infectious diseases consultation.

METHODS: We retrospectively reviewed the medical records of 193 patients diagnosed with SUD at 3 Philadelphia hospitals between October 2023 and January 2024. Patients were identified as either being diagnosed with (n=73) or without (n=120) xylazine-related wounds. We compared the demographic and clinical features between the 2 groups.

RESULTS: Patients diagnosed with wounds were younger ( P < 0.001), more likely to be White or Hispanic and less likely to be Black/AA ( P < 0.001), more likely to have tested positive for fentanyl ( P < 0.001), amphetamines ( P < 0.001), and cocaine ( P 0.001), more likely to acknowledge injection ( P < 0.001), and more likely to leave the hospital by patient-directed discharge (PDD) ( P < 0.001). Most patients had multiple wounds (75%), and more than half (53%) had at least one wound greater than 10 cm at its widest dimension. Although most patients diagnosed with wounds received antibiotics, many did not have symptoms or signs of infection.

CONCLUSIONS: Xylazine-related wounds are highly associated with illicitly manufactured …

Functional Heterogeneity In Trophoblast Stem Cells Derived From Recurrent Pregnancy Loss Products Of Conception., Qi Fu, Keisuke Kozai, Xingrao Ke, Joe Varberg, Sheng Xia, Ashley S. Howard, Michael Lydic, Kristin Holoch, Courtney Marsh, Elin Grundberg, Kaela Varberg

Manuscripts, Articles, Book Chapters and Other Papers

Recurrent pregnancy loss (RPL), defined as two or more consecutive miscarriages, affects 1-5% of couples attempting to conceive and most frequently occurs between 6 and 8 weeks of gestation, coinciding with critical stages of placental development. Despite this temporal association, placental contributions to RPL pathogenesis remain poorly understood. We hypothesized that trophoblast lineage development, including extravillous trophoblast (EVT) and syncytiotrophoblast (STB) differentiation, are disrupted in RPL. To test this hypothesis, we established and functionally characterized human trophoblast stem (TS) cell lines derived from products of conception (POC) obtained from consenting idiopathic RPL cases. Four TS cell lines were successfully derived …

Regional Variation Of Underlying Kidney Diseases In Children Undergoing Chronic Kidney Replacement Therapy Around The Globe., Dagmara Borzych-Dużałka, Marjolein Bonthuis, Uma Ali, Yok-Chin Yap, Michael Manno, Yihui Zhai, Reyner Loza, Seema Hashmi, Naye Choi, Kenza Soulami, Judith Exantus, Mohamed S. Al Riyami, Sameh Mabrouk, Marbella Ma Angeles, Cristina Zelaya-Camacho, Henny Adriani Puspitasari, Syed Saimul Huque, Francisco Cano, Kar Hui Ng, Sevcan A. Bakkaloğlu, Jerome Harambat, Kitty J. Jager, Bradley A. Warady, Franz Schaefer

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There is a scarcity of information regarding the distribution of the diseases leading to kidney failure (KF) in children living in the emerging world. We used registry data to provide a global overview of the underlying disease spectrum in children commencing kidney replacement therapy (KRT).

METHODS: We analyzed KF causes among 23,620 children and adolescents commencing maintenance KRT in 80 countries, using data from the IPNA Global KRT Registry (including ESPN/ERA Registry), the International Pediatric Dialysis Network (IPDN), the United States Renal Data System (USRDS), and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The analysis considered …

The Resilient Study: A Retrospective, Descriptive, Correlational Investigation Of Correlates Of Oral Endocrine Therapy Adherence In Older Women With Breast Cancer., Sunny Y. Ruggeri, Cynthia L. Russell Lippincott, Gregory L. Alexander, Rebecca J. Bartlett Ellis, Steven R. Chesnut, Lori A. Erickson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Breast cancer is the most prevalent and costly cancer. Oral endocrine therapy (OET) improves survival rates and quality of life while reducing recurrence, mortality, morbidity, and medical costs. However, adherence to OET is challenging because OET is prescribed for 5-10 years. Determinants of OET nonadherence (NA) among women aged 65 and older remain poorly characterized. Existing studies are limited, often focusing on small, single-site samples and focusing on patient-level rather than multi-level determinants. Despite the unique needs of older women, research on OET-NA remains scarce.

OBJECTIVE: This study identified multi-level determinants of OET-NA in older women using ecological systems …

Targeted Epigenome Sequencing Of Eosinophils Reveals Cpg Sites And Regulatory Variants Associated With Asthma., Rébecca Dionne-Gagné, Anne-Marie Madore, Anne-Marie Boucher-Lafleur, Tomi Pastinen, Catherine Laprise

Manuscripts, Articles, Book Chapters and Other Papers

Eosinophils are pro-inflammatory cells that play a central role in asthmatic inflammation. However, few studies have examined their methylation profiles in asthma, all relying on microarray-based approaches. Here, an epigenome-wide association study in 183 purified eosinophil samples from the Saguenay-Lac-Saint-Jean asthma family cohort was performed using a custom sequencing panel targeting 4,609,564 CpGs in immune regulatory regions. Two CpG sites in MAEA and SLC9A2 genes, known to be involved in immune function, were significantly associated with asthma, while five additional sites showed suggestive associations. Integration with genotype data (7,829,429 variants) and expression counts (17,513 genes) identified significant quantitative trait loci-mediated …

Leading With Hope: A Clinical Communication Campaign To Promote Partner Hiv Testing In Assisted Partner Notification And Antenatal Care Programs In Uganda., Emily A. Hurley, Violet Gwokyala, Linda Kisaakye Nabitaka, Jolly Beyeza Kashesya, Mercylynn Agasha, Florence Namaganda, Nikolaus Schuetz, J Nalubega Ross, Joseph K B Matovu, Rhoda Wanyenze, Glenn Wagner, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

Among heterosexual couples in sub-Saharan Africa, fears of relationship dissolution and inability to bear healthy children following an HIV-positive result remain barriers to HIV testing. Recently expanded availability of pre-exposure prophylaxis (PrEP) affords a critical opportunity to promote HIV testing with reassuring communication that highlights use for relationship preservation and healthy childbearing. We aimed to develop a theoretically-grounded communication intervention to promote partner HIV testing within assisted partner notification (APN) and antenatal care (ANC) programs in Uganda. Through an 18-month iterative co-creation process, we developed the HOPE Clinical Communication Campaign (HOPE-CCC) in collaboration with a project advisory board (PAB) of …

Accelerated Weaning Of Opioids To Reduce Pharmacologic Exposure For Neonatal Opioid Withdrawal Syndrome: A Randomized Clinical Trial., Abbot R. Laptook, Adam Czynski, Rouba Chahine, Rachel G. Greenberg, P Brian Smith, Erica Oliveira, Jenna Gabrio, Barry Eggleston, Abhik Das, Jeannette Lee, Barry Lester, Dave Clark, Michele Walsh, Helen Ko, Clare Campbell Asher, Hayley Friedman, Samuel Gentle, Karishma Rao, Anup Katheria, Kristen Benninger, Sanket Jani, Mark Cody Smith, Akram Khan, Ajay Talati, Shaina Lodhi, Fernando Mena, Amanda England, Prabhu Parimi, Ranjit Kylat, Heidi Harmon, Javed Mannan, Meghan P. Howell, Tanner Wright, Jessica Snowden, Act Now Collaborative

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To determine if newborns receiving morphine or methadone as the primary pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) tolerate and receive fewer days of opioid using an accelerated wean protocol (15% decrements) compared with using a slower wean protocol (10% decrements).

STUDY DESIGN: Newborns ≥36 weeks of gestation receiving morphine or methadone for NOWS were enrolled in a pragmatic blinded, randomized multicenter trial. Newborns underwent protocol-driven weaning with decreasing opioid doses of either 15% or 10% decrements. Weaning was encouraged every 24 hours, and if signs of NOWS worsened, the preceding dose was resumed. To maintain blinding, the …

Cracking The Hive Code: A Quantitative Examination Of Queen Bee Syndrome Behaviors In K–12 Education, Katie Renee Gordon

All-Inclusive List of Electronic Theses and Dissertations

Queen Bee Syndrome (QBS) has historically been used to describe women who distance themselves from other women and hinder the advancement of female peers (Staines et al., 1974). While early explanations framed QBS as rooted in individual competitiveness, more recent scholarship suggests it may reflect responses to gender discrimination and organizational context (Derks, 2017). In K–12 education, women comprise the majority of the workforce, yet remain underrepresented in upper leadership roles, particularly the superintendency. The purpose of this study was to examine perceptions of Queen Bee Syndrome behaviors among female leaders in K–12 educational settings and to explore how internal …

Exploring The Alignment Between Medical School Outcomes With Residency Competencies: A Modified Delphi Study, Sally A. Santen, Luan Lawson, Jose A. Negrete Manriquez, Marjorie Westerveld, Laurah Turner, Anita Wilson, Phd, Yoon Soo Park, Eric S. Holmboe, Michael S. Ryan, Medical School Outcomes Milestone Study Group

JeffMD Academic Affairs

PURPOSE: Facilitation of competency-based medical education adoption would benefit from alignment between medical school (undergraduate medical education [UME]) and residency (graduate medical education [GME]) assessments. This study explores the strength of an a priori alignment of medical school assessments with residency competency domains to guide programmatic assessment and research.

METHOD: In fall 2023, the authors (US faculty with UME and GME expertise) used a 2-phase Delphi consensus approach (9 participants in phase 1 and 16 in phase 2) to independently map medical school assessments to the Accreditation Council for Graduate Medical Education competency domains (0, no association; 1, some or …

Population Pharmacokinetics And Dosing Simulations Of Pentobarbital In The Pediatric Population, Victoria Etges Helfer, Lorena Medina-Aymerich, William J. Muller, Marisa Meyer, Amira Al-Uzri, Russell Mcculloh, Chi D. Hornik, Stephen J. Balevic, Rachel G. Greenberg, Daniel K. Benjamin, Sarah G. Anderson, Daniel Gonzalez

Department of Pediatrics Faculty Papers

Pentobarbital is a barbiturate with sedative and anticonvulsant properties, occasionally used in pediatric patients for preoperative sedation, deep sedation during mechanical ventilation, and seizure control. Despite its long-standing clinical use, age-appropriate dosing remains challenging due to variability across studies and limited pediatric pharmacokinetic (PK) data. This study (NCT01431326) aimed to characterize the population pharmacokinetics of pentobarbital in pediatric patients (birth to 21 years) and evaluate dosing strategies using model-based simulations. A two-compartment population PK model, allometrically scaled to total body weight, adequately described pentobarbital plasma concentrations, with no additional covariates identified as significant. Simulations were conducted across four age groups: …

Screening For Hypertension And Diabetes In Laundromats In The Largest Hispanic-Majority City In The U.S, Nicholas A Mccann, Vanessa Schick, Jack Tsai

Faculty, Staff and Student Publications

Purpose: This study aimed to assess the prevalence of hypertension and diabetes among laundromat users in San Antonio, Texas, and explore laundromats as a novel setting for health interventions regarding these 2 conditions.

Design: This descriptive, cross-sectional study involved demographic, blood pressure and HbA1c screenings to assess the health status of laundromat users.

Setting: The study took place in 7 laundromats in low-income areas of San Antonio.

Subjects: A total of 150 adults aged 18 and older who regularly used the laundromats and spoke either English or Spanish were eligible to participate.

>Measures: Hypertension was defined as a systolic BP …

Associations Of Blood Biomarkers Of Glial Cell Dysfunction And Neuronal Injury With Future Cognitive Decline And Incident Dementia, Srishti Shrestha, Xiaoqian Zhu, B Gwen Windham, Kevin J Sullivan, Priya Palta, Rebecca F Gottesman, Russell P Tracy, Clifford R Jack, Petrice M Cogswell, Prashanthi Vemuri, Sudha Seshadri, Thomas H Mosley, Michael E Griswold, Myriam Fornage

Faculty, Staff and Student Publications

Introduction: Prospective studies of blood-based biomarkers reflecting pathogenic processes, other than Alzheimer-specific pathologies, that contribute to dementia in diverse cohorts are lacking.

Methods: We jointly fitted linear mixed-effect models and proportional hazards models to examine associations of midlife glial fibrillary acidic protein (GFAP), chitinase-3-like protein 1 (YKL-40), soluble cluster of differentiation-14 (sCD14), neurofilament light chain (NfL), total tau (t-tau), and ubiquitin C-terminal hydrolase L1 (UCHL1) levels in serum (collected in 1993 to 1995) with cognitive decline and incident dementia (ascertained over 29 years through 2022) in the community-based Atherosclerosis Risk in Communities Study. sCD14 and YKL-40 were measured in 3082 …

Perceived Neighborhood Environment And Objectively Assessed, Habitual Physical Activity Among Us Adults: An All Of Us Research Program Study, Natalia I Heredia, Michael C Robertson, Christopher D Pfledderer, Ethan T Hunt, Timothy J Walker, Deborah Salvo

Faculty, Staff and Student Publications

Introduction: The purpose of this study was to assess the associations between perceived socioenvironmental neighborhood attributes and objectively assessed habitual physical activity among US adults as well as whether associations vary by sociodemographic characteristics.

Methods: We used data from the All of Us research program, a longitudinal cohort study of a diverse sample of Americans. Perceived neighborhood social cohesion, physical and social disorder, walkability, and sociodemographic characteristics were self-reported. Habitual physical activity was ascertained using Fitbit-derived step counts over ≥24 weeks. Generalized additive mixed-effects models were used to test the associations between perceived socioenvironmental neighborhood attributes and daily step counts. …

A Bilingual Ai-Based Chatbot For Nutrition Education In A Food Is Medicine Intervention For High-Risk Pregnant Women: Design And Development Study, Lorena Macias-Navarro, Nalini Ranjit, Gregory W Bounds, Brendon A Providence, Yesmeena Shmaitelly, Naomi M Tice, Shreela V Sharma

Faculty, Staff and Student Publications

Background: Conversational agents (artificial intelligence [AI]-based chatbots) offer a novel approach to health interventions by providing personalized, adaptive interactions that improve over time based on user engagement. In nutrition education, given the wide variation in knowledge, skills, and abilities across participants, AI-based chatbots have the potential to enhance accessibility, engagement, and behavior change. Food is Medicine (FIM) interventions, which aim to improve food security and diet quality among multicultural, at-risk populations, often face challenges related to sustained engagement and use.

Objective: This paper describes the design, development, and iterative refinement of a bilingual AI-driven nutrition chatbot integrated into an FIM …

Assessing Trauma Triage Tools: The Cribari Matrix Method And Modified Need For Trauma Intervention., Olivia Houck, Nathaniel C Brophy, Danielle Rossler, Roxanna Giambri, Deanah Moore, Sara Arida, Melody Campbell, Richard L George

Emergency Medicine and Trauma

BACKGROUND: Assessment of triage procedures is crucial for improving patient care. Most programs evaluate under- and over-triage using the ISS-based Cribari Matrix Method (CMM), but tools such as the critical-intervention-based Need for Trauma Intervention (NFTI) and its time-critical modified version (mNFTI) focus on identifying patients who need immediate resources. The mNFTI has seen limited empirical inquiry in assessing triage procedures.

OBJECTIVE: To assess accuracy and agreement rates between mNFTI and CMM.

METHODS: This multicenter, retrospective cohort study compared triage classifications in trauma patients using 2019 trauma registry data from trauma centers across 5 trauma systems in Ohio, United States. Patients …

The Rodent Electronic Nicotine Delivery System (Rends): Effects Of Age On Self-Administration Of Inhaled Nicotine In Female Rats, Daniel Santos Da Silva

All Graduate Theses and Dissertations, Fall 2023 to Present

Smoking tobacco is the leading avoidable cause of death and drives many health problems. Nicotine, the main chemical in tobacco products, keeps people using it. This study used the Rat Electronic Nicotine Delivery System (RENDS), an inexpensive and freely shared, to examine e-cigarette use in adolescent and adult female rats by exploring four phases of nicotine delivered and not delivered to understand use patterns among ages. Our study found that both adolescent and adult female rats chose to inhale nicotine when given the opportunity, showing drug-seeking behavior. Overall, nicotine use was similar between ages. These results could help inform therapies, …

Momentary Assessment Of Mental Imagery And Pain-Related Psychological Factors In Youth With Chronic Pain, Jemma Todd, Brydee Pickup, Julie Ji, Alice Norton, Emily A Holmes, Louise Sharpe

School of Psychology

Mental imagery is a powerful cognitive process implicated in various psychological disorders, yet its role in chronic pain remains underexplored. This study examined the temporal relationship between mental imagery, pain-related psychological constructs, and pain outcomes in young adults with chronic pain. A sample of 121 university students with chronic pain completed baseline assessments of mental imagery (tendency, ability, intrusive imagery), pain-related psychological constructs (interpretation bias, fear of progression, pain anxiety), and general psychological constructs (depression, anxiety, stress, emotion regulation difficulties, trauma symptoms). Participants then completed an ecological momentary assessment delivered by smartphone app 3 times daily for 1 week, reporting …

Long Covid Persistence And Surveillance Gaps Across 58 Us Hospitals, Jiazi Tian, Alaleh Azhir, Matthew Decaro, Ngan Chau, Jonas Hügel, Michele Morris, Jingya Cheng, Pedram Fard, Ingrid V Bassett, Douglas S Bell, Elmer V Bernstam, Shyam Visweswaran, Jeffrey G Klann, Shawn N Murphy, Hossein Estiri

Faculty, Staff and Student Publications

Importance: Surveillance of postacute sequelae of SARS-CoV-2 infection (PASC) depends on diagnostic coding systems that capture fewer than one-half of affected individuals, rendering millions invisible to health systems and policymakers.

Objective: To quantify the gap between true PASC burden and diagnostic code-based estimates, determine the proportion representing chronic disease, and characterize organ system heterogeneity and temporal trends across diverse populations.

Design, setting, and participants: This retrospective cohort study used electronic health record data from 58 hospitals and affiliated clinics in 4 US regions, from 2017 to 2025. Adults (aged ≥18 years) with laboratory-confirmed SARS-CoV-2 infection or a COVID-19 diagnosis code …

Severe, Non-Apneic Respiratory Dysfunction And Hypoxia Following Generalized Convulsive Seizures, Haley E Pysick, Rup K Sainju, Roshni Nair, Deidre N Dragon, Eduardo Bravo, Laura Vilella, Xiaojin Li, Samden D Lhatoo, George B Richerson, Brian K Gehlbach

Faculty, Staff and Student Publications

Objective: Sudden unexpected death in epilepsy (SUDEP) is a devastating consequence of some generalized convulsive seizures (GCS). Recent work has focused on seizure related apnea as a biomarker of SUDEP risk, frequently without characterizing the adequacy of non-apneic ventilation or identifying other dysfunctional breathing patterns. We hypothesized that GCS frequently induce immediate, severe, non-apneic respiratory dysfunction that can induce critical hypoxia and bradycardia and sought to characterize breathing patterns after GCS.

Methods: Adult patients admitted to an epilepsy monitoring unit were studied. The effects of GCS on breathing and heart rate were analyzed using nasal pressure transducers, chest and abdominal …

Assessment Of Skin In Patients With Systemic Sclerosis Using High-Frequency Ultrasound And Shear Wave Elastography: A Comparative Study With Histology, Molecular, And Clinical Parameters, Ruhani Desai, Filemon Tan, Minghua Wu, Jeffery L Browning, Samuel Theodore, Meng Zhang, Brian Skaug, Harshdeep Singh Chawla, Manmohan Singh, Salavat Aglyamov, Kirill V Larin, Maureen Mayes, Shervin Assassi

Faculty, Staff and Student Publications

Objective: Ultrasound (US) has been proposed as a potential tool for assessing skin fibrosis in systemic sclerosis (SSc). However, a large-scale comparison of US-based assessment with histologic markers of skin fibrosis has not been reported. We evaluated US-based skin assessments for their face validity (differentiation between involved SSc and healthy control [HC] skin), construct validity (comparison to modified Rodnan skin score [mRSS]), and criterion validity (comparison to histologic and gene expression fibrosis markers).

Methods: Twenty HCs and 52 patients with SSc underwent clinical and US assessment followed by a forearm skin biopsy. Predefined areas were assessed on the finger, hand, …

Brief Report: Hepatitis B Vaccination Histories In Persons With Hiv Needing Revaccination, Minhee Kang, Triin Umbleja, Anchalee Avihingsanon, Sandra W Cardoso, Josphat Kosgei, Karen J Vigil, Ta Thi Dieu Ngan, Unoda Chakalisa, Stephanie Caruso, Kenneth E Sherman, Kristen M Marks

Faculty, Staff and Student Publications

Introduction: Past studies of hepatitis B vaccines in people with HIV (PWH) have shown mixed results about improving responses with increases in dose or dose frequency, leading to inconsistent guidelines and practice. We examined vaccine series completion and revaccinations in PWH lacking a seroprotective response.

Methods: Hepatitis B vaccination histories were evaluated as a retrospective study in 561 participants of A5379 trial (NCT04193189). Individuals in 41 sites in Africa, Asia, South America, and the United States qualified for the trial with antibody titers below the seroprotective level (< 10 mIU/mL) despite past hepatitis B vaccinations. The primary measure of interest was the number of vaccines in the past vaccination records.

Results: Of the 1098 trial candidates, 561 (51%) did not …

Risk-Stratified Transitional Care And Cardiovascular Hospitalizations By Sex: A Secondary Analysis Of A Randomized Clinical Trial., Douglas S Lee, Chang Nancy Wang, Peter C Austin, Sharon E Straus, Michael E Farkouh, Alice Chong, Monica Taljaard, Stephanie Poon, Stuart Smith, Robert S Mckelvie, Robert M Iwanochko, Andrea Macdougall, Esam Elbarasi, Peter M Cram, Jiming Fang, Clare L Atzema, Jacob A Udell, Paula A Rochon, Michael J Schull, Susanna Mak, Heather J Ross

Heart and Vascular Articles

IMPORTANCE: Female patients with heart failure (HF) are older and more often present with preserved left ventricular ejection fraction (LVEF), whereas male patients present with more ischemic disease. Despite these differences, an emergency department-based acute HF strategy may be equally applicable to both sexes.

OBJECTIVE: To determine whether the strategy for acute HF management in the Comparison of Outcomes and Access to Care for Heart Failure (COACH) trial differed by sex.

DESIGN, SETTING, AND PARTICIPANTS: This prespecified secondary analysis of the multicenter COACH stepped-wedge, cluster-randomized clinical trial included 10 acute care hospitals in Ontario, Canada. Data were collected from January …

Are Drains After Trauma Splenectomy Associated With Organ Space Surgical Site Infections?, Stephanie Martinez Ugarte, Mokunfayo O Fajemisin, Seokhun Kim, William D Rieger, Renee W Green, Gabrielle E Hatton, Lillian S Kao

Faculty, Staff and Student Publications

Introduction: Left upper quadrant (LUQ) drain use after trauma splenectomy varies, with minimal existing data to guide practice. We aimed to investigate the association of LUQ drains with organ space surgical site infection (OS-SSI) after splenectomy. We hypothesized that LUQ drains after trauma splenectomy are associated with increased odds of OS-SSI.

Patients and methods: A retrospective study of adult blunt trauma patients who underwent splenectomy from 7/2018 to 6/2024 was performed. We excluded patients who survived < 5 days after operation, and those with an intraoperatively identified pancreatic injury. Demographics, surgical details, and drain information were abstracted from the medical record. Inverse probability of treatment weighting (IPTW) was used to balance variables between patients who did and did not receive an LUQ drain after splenectomy. Multivariable logistic regression with IPTW was performed to estimate the association of LUQ drains with OS-SSI.

Results: Of 179 patients, 68% (n = 121) were male, the median age was 38 years (interquartile range 28, 55), and 27% (n = …

Aspirin And Preterm Birth Among Pregnant People With Increased Heat Exposure: Secondary Analysis Of A Randomized Clinical Trial, Gabriella Meltzer, Luke Duttweiler, Sarah Saleem, Kartik Shankar, Manolo Mazariegos, Antoinette Tshefu, Jackie Patterson, Elwyn Chomba, Waldemar Carlo, Shivaprasad Goudar, Richard Derman, Archana Patel, Patricia Hibberd, Edward Liechty, Fabian Essamai, Edwin Asturias, Denise Babineau, Janet Moore, Cascade Tuholske, Andrew Zimmer, Brent Coull, Elizabeth Mcclure, Robert Goldenberg, Nancy Krebs, Matthew Hoffman, Blair Wylie

Global Health Articles

IMPORTANCE: Scalable interventions are urgently needed to mitigate the adverse effects of heat on pregnancy and newborn health.

OBJECTIVE: To evaluate whether low-dose aspirin modifies the association between heat exposure and preterm birth.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the Global Network for Women's and Children's Health Research Aspirin Supplementation for Pregnancy Indicated Risk Reduction in Nulliparas (ASPIRIN) randomized, double-blinded, placebo-controlled clinical trial was conducted from March 2016 to June 2018. Statistical analyses were performed from June 2024 to June 2025. The study settings included the Democratic Republic of Congo, Zambia, Kenya, Guatemala, Pakistan, and Belagavi and Nagpur, …

Adaptive Evolution Of Gene Regulatory Networks In Mammalian Neocortex, Zhuo Li, Linda J Richards, Et Al.

2020-Current year OA Pubs

Mammals have evolved a more complex brain, exemplified by the transformation of the single-layer dorsal cortex of excitatory projection neurons (ExNs) in ancestors into a multilayered cerebral neocortex

Hematopoietic Cell Transplant Access And Patient Diversity, Rachel Cusatis, Ramzi Abboud, Et Al.

2020-Current year OA Pubs

IMPORTANCE: Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor.

OBJECTIVE: To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included adult participants (aged ≥18 years) from 3 …

The First Cut Is The Deepest: Understanding Learner Trauma In The Emergency Medicine Clerkship, Dimitrios Papanagnou, Leela Raj, Karen E. Watkins, Xiao C. Zhang, Andres Fernandez, Md, Victoria J. Marsick

Department of Emergency Medicine Faculty Papers

BACKGROUND: As third-year medical students transition into high-stakes, high-stress clinical environments like the emergency department (ED), they may experience significant personal trauma. However, little is known about how this trauma is experienced early in their training - specifically during the transition from preclinical to clinical learning environments. This study addresses that gap by exploring third-year medical students' experiences of trauma during the emergency medicine (EM) clerkship through the lens of Trauma-Informed Care (TIC) and identifies workplace factors and intersectional demographics influencing these experiences.

METHODS: This qualitative study used the critical incident technique to explore emotionally-significant events encountered by third-year medical …

Safety And Efficacy Of Individualised Exercise And Nad+ Precursor Supplementation In Patients With Friedreich’S Ataxia In The Usa: A Single-Centre, 2 × 2 Factorial, Randomised Controlled Trial, Kimberly Lin, Anna Bucha, Kara Mcsweeney, Kristin Wade, Antoneta Karaj, Jaclyn Tamaroff, Shannon O'Malley, Nicole Chung, Nicolette Cilenti, Julianne Wanner, Gabriel Adzika, Clementina Mesaros, Ian Blair, Teerapat Rojsajjakul, Suraj Serai, Jennifer Farmer, Kyle Bryant, Yingying Lu, Michael Harhay, David Weber, Stephen Paridon, Erin Seifert, Mary Putt, Payman Zamani, Joseph Baur, David Lynch, Shana Mccormack

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND:Friedreich's ataxia is a rare, chronic, progressive, neurodegenerative condition affecting multiple organ systems, including neurological, musculoskeletal, cardiac, and endocrine systems, and is marked by low cardiopulmonary fitness. We tested the effect of exercise and NAD⁺ precursor supplementation with nicotinamide riboside, which have each shown benefits in animal and early clinical studies, on cardiopulmonary fitness in individuals with Friedreich's ataxia.

METHODS: This 12-week, outpatient, phase 2, single-site (Children's Hospital of Philadelphia, Philadelphia, PA, USA), randomised, 2 × 2 factorial clinical trial recruited individuals aged 10–40 years with an ejection fraction of 45% or greater who were able to exercise. A …

A Covalent Allosteric Molecular Glue Suppresses Nrf2-Dependent Cancer Growth, Nilotpal Roy, Ilah Bok, Harit Panda, Dhaval P Bhatt, Emily M Wilkerson, Soma Saeidi, Paul Zolkind, Michael B Major, Et Al.

2020-Current year OA Pubs

UNLABELLED: The NRF2 transcription factor is constitutively active in cancer, in which it functions to maintain oxidative homeostasis and reprogram cellular metabolism. NRF2-active tumors exhibit NRF2 dependency and resistance to chemotherapy/radiotherapy (RT). In this study, we characterize VVD-065, a first-in-class NRF2 inhibitor that acts via an unprecedented allosteric molecular glue mechanism. In the absence of stress or mutation, NRF2 is rapidly degraded by the Kelch-like ECH-associated protein 1 (KEAP1)-cullin3 (CUL3) ubiquitin-ligase complex. VVD-065 specifically and covalently engages Cys151 on KEAP1, which in turn promotes KEAP1-CUL3 complex formation, leading to enhancement of NRF2 degradation. Previously reported Cys151-directed compounds decrease KEAP1-CUL3 interactions …

Optical Coherence Tomography As An Emerging Technique For Identifying Pediatric Middle Ear Effusion, Roger Neuberger, Jeffrey Carter, Adriana Dives, Ana Sofia C Ibarrola, Maritsa Ixba, Elton Lambert, Yi-Chun Liu, Anna H Messner

Faculty, Staff and Students Publications

Objective: Acute otitis media (AOM) and otitis media with effusion (OME) rely on accurate characterization of middle ear effusion (MEE). Optical coherence tomography (OCT) is a potential modality for noninvasive analysis of MEE, thereby assisting with otitis media diagnosis. This study aims to compare the diagnostic performance of OCT with otoscopy and tympanometry in pediatric patients.

Methods: A prospective convenience sample of 164 pediatric patients aged 6 months to 12 years was recruited from two tertiary care pediatric otolaryngology clinics. During their visit, each child underwent otoscopy, tympanometry, and OCT evaluation. Scans were reviewed by both a fellowship-trained pediatric otolaryngologist …