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Conceptualizing Caremark, Roy Shapira Jan 2025

Conceptualizing Caremark, Roy Shapira

Indiana Law Journal

Who is accountable for corporate compliance failures? The issue of compliance has emerged as one of the most significant developments in corporate governance over the past decades. However, until recently, corporate law has had surprisingly little to say about the question, leaving the policing of issues such as toxic pollution, product safety, or data privacy, to other regulators. This situation has changed dramatically over the past few years. Today, virtually every corporate fiasco is followed by an oversight duty lawsuit against the company’s directors and officers for not doing enough to prevent the debacle. But the rapid resurgence of oversight …


Federalism, State Action, And Workers' Medical Privacy, Ani B. Satz Jan 2025

Federalism, State Action, And Workers' Medical Privacy, Ani B. Satz

Indiana Law Journal

Injured workers entering state workers’ compensation systems effectively forego their medical privacy. This is due to widespread judicial misinterpretation of the HIPAA Privacy Rule (HPR) as excluding injured workers from federal medical privacy protections. As a result, medical privacy for workers’ compensation claims is effectively governed by state law. This Article argues that states have failed to protect the medical privacy of injured workers adequately and that there is a pressing need for legislative reform. The Article presents the first comprehensive survey in the legal literature of state action protecting the medical privacy of injured workers. Part I describes the …


Enhancing Patient-Centered Care Through Predictive Modeling To Optimize Appointment Scheduling In Pediatric Care, Linda Anna Penitusi-Burford Jan 2025

Enhancing Patient-Centered Care Through Predictive Modeling To Optimize Appointment Scheduling In Pediatric Care, Linda Anna Penitusi-Burford

Doctor of Business Administration (DBA)

This study evaluated the predictive performance of three forecasting models—Autoregressive Integrated Moving Average (ARIMA), Prophet, and Long Short-Term Memory (LSTM)—to determine which most accurately forecasts pediatric appointment availability. The research was guided by the theory that accurate forecasting can enhance healthcare scheduling by aligning appointment supply with patient demand, thereby advancing patient-centered care (PCC).

A quantitative, comparative design was employed using two years of pediatric online scheduling records. The methodological framework incorporated multiple forecast horizons (30–180 days) and statistical analyses, including ANOVA, paired sample t-tests, and regression. Model performance was assessed using standard error metrics: Mean Absolute Error (MAE), Mean …


Remarks On The 20th Anniversary Of The Founding Of The District Of Columbia Access To Justice Commission, Anna Blackburne-Rigsby Jan 2025

Remarks On The 20th Anniversary Of The Founding Of The District Of Columbia Access To Justice Commission, Anna Blackburne-Rigsby

University of the District of Columbia Law Review

I'm very excited to be here and honored that you invited me to be one of the speakers for this very timely and amazing symposium. I'm especially excited because you're also recognizing the 20th anniversary of the District of Columbia's Access to Justice Commission. The topic of the symposium is the evolution of the legal profession, A Different World. Looking at the phoenix on the UDC Law school logo, the flames are really appropriate now when we talk about the evolution of the legal world with all the technological developments and other interesting issues that we confront.

First, I want …


Resource Map Of Expenditures For Tennessee Children And Youth, Annual Report To The Legislature 2025, Tennessee. Commission On Children And Youth. Jan 2025

Resource Map Of Expenditures For Tennessee Children And Youth, Annual Report To The Legislature 2025, Tennessee. Commission On Children And Youth.

Resource Map Report

No abstract provided.


The Relevance Of Dnajb1 Protein Dimerization Against The Human Neurodegenerative Diseases, Erina Kotreli, Trang Le, Szymon Ciesielski Jan 2025

The Relevance Of Dnajb1 Protein Dimerization Against The Human Neurodegenerative Diseases, Erina Kotreli, Trang Le, Szymon Ciesielski

Dean's Leadership Council Library Research Prize

All biological functions in living organisms depend on the activity of proteins, long molecules that must twist and fold into specific shapes to become functional. A subset of proteins known as molecular chaperones is essential for maintaining cellular health by assisting other proteins in folding correctly and refolding those damaged by stress. When proteins misfold and clump together, they can form toxic aggregates linked to many neurodegenerative diseases, including Alzheimer’s disease (AD), one of the leading causes of death in the United States. In AD, these protein aggregates form organized, elongated structures referred to as amyloid-like fibrils, which damage neurons …


Archaeological Survey And Testing At Site 38bu1834, United States Marine Corps Recruit Depot, Parris Island, South Carolina, Chester B. Depratter, James B. Legg, Heathley A. Johnson Jan 2025

Archaeological Survey And Testing At Site 38bu1834, United States Marine Corps Recruit Depot, Parris Island, South Carolina, Chester B. Depratter, James B. Legg, Heathley A. Johnson

Research Manuscript Series

This report covers the archaeological investigations at site 38BU1834, which falls within the boundary of the Charlesfort/Santa Elena National Historic Landmark on Parris Island, South Carolina. Initial investigations involved a search for activity areas associated with the Spanish pottery kiln discovered in 1993 near the golf course clubhouse. Later work on the site focused on a pond or sinkhole containing a deposit of World War I era U. S. Marine Corps trash and the prehistoric period earth and shell mounds that line the periphery of the pond/sinkhole.


State Schooling Policies And Cognitive Performance Trajectories: A Natural Experiment In A National Us Cohort Of Black And White Adults, Min Hee Kim, Sze Yan Liu, Willa D. Brenowitz, Audrey R. Murchland, Thu T. Nguyen, Jennifer J. Manly, Virginia J. Howard, Marilyn D. Thomas, Tanisha Hill-Jarrett, Michael Crowe, Charles F. Murchison, M. Maria Glymour Jan 2025

State Schooling Policies And Cognitive Performance Trajectories: A Natural Experiment In A National Us Cohort Of Black And White Adults, Min Hee Kim, Sze Yan Liu, Willa D. Brenowitz, Audrey R. Murchland, Thu T. Nguyen, Jennifer J. Manly, Virginia J. Howard, Marilyn D. Thomas, Tanisha Hill-Jarrett, Michael Crowe, Charles F. Murchison, M. Maria Glymour

Department of Public Health Scholarship and Creative Works

Background: Education is strongly associated with cognitive outcomes at older ages, yet the extent to which these associations reflect causal effects remains uncertain due to potential confounding. Methods: Leveraging changes in historical measures of state-level education policies as natural experiments, we estimated the effects of educational attainment on cognitive performance over 10 years in 20,248 non-Hispanic Black and non-Hispanic White participants, aged 45+ in the Reasons for Geographic and Racial Disparities in Stroke cohort (2003-2020) by (1) using state- and year-specific compulsory schooling laws, school-term length, attendance rate, and student-teacher ratio policies to predict educational attainment for US Census microsample …


Educators’ Perceptions Of The Components That Influence Student Behavior And The Impact Restorative Practices And Community Circles Have On Improving Overall Well-Being In Students, Catherine Dulovic Jan 2025

Educators’ Perceptions Of The Components That Influence Student Behavior And The Impact Restorative Practices And Community Circles Have On Improving Overall Well-Being In Students, Catherine Dulovic

Selected Full Text Dissertations, 2011-

Restorative Practices have been utilized in many schools as an alternative to traditional disciplinary methods. Traditional methods such as Out of School Suspension (OSS) and In-School Suspension (ISS) can lead to feelings of isolation and impact students’ attitudes towards school and community. Community Circles are often used in conjunction with Restorative Practices to support the development of the whole child, build relationships, promote positive discipline, and create a trauma sensitive environment that includes mindfulness practices. The current research examined educators’ perspective of the components that influence student behavior and the impact Restorative Practices and Community Circles have on improving behavior …


Affordance-Based Information Technology Sensemaking [Abits], Arvin Mesgari, Chitu Okoli, Ana Ortiz De Guinea Jan 2025

Affordance-Based Information Technology Sensemaking [Abits], Arvin Mesgari, Chitu Okoli, Ana Ortiz De Guinea

Information Systems and Business Analytics Faculty Works

Information Technology (IT) use gives rise to a wide variety of outcomes. This stems in part from the divergent ways in which individuals understand technology. While the sensemaking literature unveils how meaning is attached to organizational phenomena via cognitive and social processes, it overlooks the discovery dimension of making sense, that is detecting the role of the IT artifact in bringing about outcomes. In other words, there is a need to explain how the IT artifact contributes to technology sensemaking and its outcomes. This paper presents a framework that enables scholars to analyze the IT artifact’s role in technology sensemaking …


The Moderating Role Of Hospital Staffing Levels On The Effectiveness Of Clinical Decision Support Systems In Mitigating Patient Readmission Rates, Youyou Tao, Arindam Brahma, Kevin Baldwin, Rui Sundrup, Dezhi Wu Jan 2025

The Moderating Role Of Hospital Staffing Levels On The Effectiveness Of Clinical Decision Support Systems In Mitigating Patient Readmission Rates, Youyou Tao, Arindam Brahma, Kevin Baldwin, Rui Sundrup, Dezhi Wu

Information Systems and Business Analytics Faculty Works

Healthcare staffing shortages and high 30-day readmission rates are pressing challenges in today's healthcare systems. While extensive studies have explored the positive impact of Health Information Technology (HIT) on health outcomes, the effect of hospital staffing on HIT effectiveness, particularly Clinical Decision Support Systems (CDSS), is underexplored. Therefore, we examine whether physician and resident staffing levels moderate the impact of CDSS on 30-day readmission rates. After analyzing data from 1,605 hospitals in the United States from 2017 and 2018, we found that the effect of CDSS implementation in reducing 30-day readmission rates is more pronounced in hospitals with lower bed-to-physician …


A Preliminary Program Evaluation: Rates Of Intimate Partner Violence In An Urban Child Welfare Prevention Program, Athena Roca Jan 2025

A Preliminary Program Evaluation: Rates Of Intimate Partner Violence In An Urban Child Welfare Prevention Program, Athena Roca

PCOM Psychology Dissertations

Intimate partner violence (IPV) remains a pervasive public health concern with significant consequences for families. Traditional batterer intervention programs (BIPs), which often focus solely on the person causing harm (PCH), have demonstrated limited success in reducing recidivism, particularly when grounded in punitive or authoritarian models. This study evaluated the Child-Welfare IPV Prevention Program (CWIPVPP), a family-centered, trauma-informed intervention that engages the PCH, co-parents, and children to reduce IPV-related behaviors and promote healthier family functioning.

Recidivism indicators, including domestic violence incident reports (DIRs) and arrests, were analyzed for 57 fathers referred to the program, with 53 retained for final analyses. A …


Targeting Rna Polymerase I In Ewing Sarcoma Treatment, Alexis Bruce, Gavin Anchondo, Rebekah Carter, Sergio Guerrero Pacheco, Hema Sri Kambala, Elizabeth Cortez, Kyra Parker, Le Su Jan 2025

Targeting Rna Polymerase I In Ewing Sarcoma Treatment, Alexis Bruce, Gavin Anchondo, Rebekah Carter, Sergio Guerrero Pacheco, Hema Sri Kambala, Elizabeth Cortez, Kyra Parker, Le Su

Research, Publications & Creative Work

Ewing sarcoma (ES) is a high-grade bone and soft tissue tumor in adolescents and young adults. Cytotoxic chemotherapy does not improve prognosis, especially for advanced ES patients who have a 5-year survival of 30% or less [1, 2]. Molecular targeted therapy emerges as a promising strategy to battle ES, given its unique driver mutations resulting from the fusion of the EWS and one of the ETS genes, but the feasibility of directly blocking EWS-ETS function has not yet been established [3]. To search for new therapeutic targets, we began with an analysis of the Cancer Dependency Map (DepMap) datasets that …


Exploring Minority Students’ Perceptions Of Using Open Educational Resources In A Computer Game Design Course, Yu-Tung Kuo, Yu-Chun Kuo, Hungwei Tseng Jan 2025

Exploring Minority Students’ Perceptions Of Using Open Educational Resources In A Computer Game Design Course, Yu-Tung Kuo, Yu-Chun Kuo, Hungwei Tseng

Research, Publications & Creative Work

With the increasing use of open educational resources (OERs) in higher education, and the potential of OERs to enhance student learning, this study investigated minority students’ perceptions of using OERs in learning computer programming. The influence of minority students’ OER perceptions on their learning outcomes, as well as the relationships of the perception variables were explored. The participants were minority students from an HBCU institution in the southeastern United States. Quantitative approaches were used to analyze the collected data. The results indicated that the minority students’ perceptions of using OERs had a significant influence on their perceived learning outcomes in …


High-Dose Beta-Alanine Supplementation For Two Weeks Did Not Enhance Intermittent Endurance Or Sprint Performance In Trained Futsal Players, Hossein Miraftabi, Erfan Berjisian, Marzieh Nouri Dizicheh, Alireza Naderi, Masoud Bodaghi, Majid Koozehchian, Fatemeh Shabkhiz, Alvaro Lopez-Samanes Jan 2025

High-Dose Beta-Alanine Supplementation For Two Weeks Did Not Enhance Intermittent Endurance Or Sprint Performance In Trained Futsal Players, Hossein Miraftabi, Erfan Berjisian, Marzieh Nouri Dizicheh, Alireza Naderi, Masoud Bodaghi, Majid Koozehchian, Fatemeh Shabkhiz, Alvaro Lopez-Samanes

Research, Publications & Creative Work

Background: This study aimed to investigate the effects of a high-dose beta-alanine (BA) supplementation on physical performance, blood lactate concentration, and ratings of perceived exertion (RPE) in trained futsal players. Methods: Sixteen trained futsal players participated in a randomized, parallel, double- blind experiment, completing a two-week supplementation period with either 12 g/day of BA (n = 8; age: 19 ± 2 years; height: 1.78 ± 0.03 m; body mass: 68.5 ± 5.4 kg) or a placebo (PLA) (n = 8; age: 18 ± 1 years; height: 1.74 ± 0.08 m; body mass: 65.6 ± 6.4 kg). Athletes completed the futsal …


Trends In U.S. Health Care Bankruptcy: A 10-Year Retrospective, Amy Yarbrough Landry, Philip Cendoma, Kristine R. Hearld, J'Aime C. Jennings, Robert J. Landry Iii Jan 2025

Trends In U.S. Health Care Bankruptcy: A 10-Year Retrospective, Amy Yarbrough Landry, Philip Cendoma, Kristine R. Hearld, J'Aime C. Jennings, Robert J. Landry Iii

Research, Publications & Creative Work

Background: In recent years, the United States (U.S.) healthcare system has faced financial challenges resulting from changing reimbursement models, fluctuations in sources of investment, and a global pandemic. These factors have resulted in an influx of bankruptcy filings among healthcare organizations. This study explores the number of healthcare organizations filing for bankruptcy as means to reorganize (Chapter 11) or liquidate assets (Chapter 7), and examines whether organizational size, defined by assets and liabilities, influences the success of reorganization. The research on bankruptcy among healthcare organizations has been limited to larger businesses including hospitals and nursing homes. This study investigates all …


Dose–Response Effects Of Short-Term Rhodiola Rosea (Golden Root Extract) Supplementation On Anaerobic Exercise Performance And Cognitive Function In Resistance-Trained Athletes: A Randomized, Crossover, Double-Blind, And Placebo-Controlled Study, Majid Koozehchian, Andrew T. Newton, Gina Mabrey, Faith M. Bonness, Rafaela Rafajlovska, Alireza Naderi Jan 2025

Dose–Response Effects Of Short-Term Rhodiola Rosea (Golden Root Extract) Supplementation On Anaerobic Exercise Performance And Cognitive Function In Resistance-Trained Athletes: A Randomized, Crossover, Double-Blind, And Placebo-Controlled Study, Majid Koozehchian, Andrew T. Newton, Gina Mabrey, Faith M. Bonness, Rafaela Rafajlovska, Alireza Naderi

Research, Publications & Creative Work

Background: Rhodiola rosea (RR) is marketed as an adaptogen; however, evidence for acute/short-term effects—and especially dose–response effects—in trained adults across performance and cognition is limited.

Objective: Test whether RR improves resistance performance (strength, power) and executive function in resistance-trained adults using a randomized crossover with placebo and a capsule-free baseline.

Methods: In a randomized, double-blind, crossover trial with four conditions—no-capsule control (CON), placebo (PL), low-dose RR (LDRR), and high-dose RR (HDRR). Twenty-seven resistance-trained adults completed the conditions. Day-7 testing included bench press (BP) and leg press (LP) 1-repetition maximum (1RM); a third set to failure at 60% 1RM with set-3 …


Formulation Development Of Dual-Compartment Topical Inserts Combining Tenofovir Alafenamide And Elvitegravir For Flexible On-Demand Hiv Prevention, Vivek Agrahari, M. Melissa Peet, Neelima Chandra, Prakash Ramalingam, Pardeep K. Gupta, Sriramakamal Jonnalagadda, Onkar N. Singh, Timothy J. Mccormick, Gustavo F. Doncel, Meredith R. Clark Jan 2025

Formulation Development Of Dual-Compartment Topical Inserts Combining Tenofovir Alafenamide And Elvitegravir For Flexible On-Demand Hiv Prevention, Vivek Agrahari, M. Melissa Peet, Neelima Chandra, Prakash Ramalingam, Pardeep K. Gupta, Sriramakamal Jonnalagadda, Onkar N. Singh, Timothy J. Mccormick, Gustavo F. Doncel, Meredith R. Clark

Department of Obstetrics & Gynecology Faculty Publications

Pre-exposure prophylaxis (PrEP) has emerged as a prominent approach for the prevention of HIV infections. While the latest advances have resulted in effective oral and injectable product options, there are still gaps in on-demand, event-driven, topical products for HIV prevention that are safe and effective. Here we describe the formulation development of a dual-compartment topical insert containing tenofovir alafenamide fumarate (TAF) and elvitegravir (EVG) that may be administered when needed, vaginally or rectally, pre- or post-coitus, for flexible HIV prophylaxis. Specifically, we describe the lab-scale formulation development, preclinical mucosal safety and pharmacokinetics (PK) testing in rabbits, long-term stability, and scale-up …


In Danger: Hiv Vaccine Research And Development In Europe, Roger Tatoud, Yves Lévy, Roger Le Grand, Jose Alcami, Giorgio Barbareschi, Christian Brander, Andrea Cara, Behazine Combadière, François Dabis, Sarah Fidler, Tomáš Hanke, Carolina Herrera, Gunilla B. Karlsson Hedestam, Hester Kuipers, Sheena Mccormack, Christiane Moog, Giuseppe Pantaleo, Laura Richert, Rogier W. Sanders, Robin Shattock, Hendrik Streeck, Rodolphe Thiebaut, Alexandra Trkola, Klaus Üeberla, Marit J. Van Gills, Ralf Wagner, Winfried Weissenhorn, Yazdan Yazdanpanah, Gabriella Scarlatti, Jean Daniel Lelièvre Jan 2025

In Danger: Hiv Vaccine Research And Development In Europe, Roger Tatoud, Yves Lévy, Roger Le Grand, Jose Alcami, Giorgio Barbareschi, Christian Brander, Andrea Cara, Behazine Combadière, François Dabis, Sarah Fidler, Tomáš Hanke, Carolina Herrera, Gunilla B. Karlsson Hedestam, Hester Kuipers, Sheena Mccormack, Christiane Moog, Giuseppe Pantaleo, Laura Richert, Rogier W. Sanders, Robin Shattock, Hendrik Streeck, Rodolphe Thiebaut, Alexandra Trkola, Klaus Üeberla, Marit J. Van Gills, Ralf Wagner, Winfried Weissenhorn, Yazdan Yazdanpanah, Gabriella Scarlatti, Jean Daniel Lelièvre

Department of Obstetrics & Gynecology Faculty Publications

Highly effective antiretroviral-based HIV prevention plays an important role in ending the global HIV/AIDS epidemic. However, the sustainable control of the epidemic is hampered by unequal access to prevention options, including HIV testing, alongside with drug resistance and ongoing barriers to accessing sustainable HIV treatment. Therefore, an HIV vaccine, combined with effective prevention and treatment, remains an absolute necessity to control the epidemic. Yet, the recent discontinuation of four major vaccine efficacy studies is raising concerns about the future of HIV vaccine research and development globally, and particularly in the European region where funding for vaccine research and development has …


Association Between The Social Vulnerability Index And Adverse Pregnancy Outcomes, Tetsuya Kawakita, Misa Hayasaka, Lindsay Robbins, Juliana Martins, George Saade Jan 2025

Association Between The Social Vulnerability Index And Adverse Pregnancy Outcomes, Tetsuya Kawakita, Misa Hayasaka, Lindsay Robbins, Juliana Martins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective: To assess the association between the Social Vulnerability Index (SVI) and racial disparities in pregnancy outcomes across U.S. counties and to quantify these racial disparities.

Methods: This was a cross-sectional study using restricted Centers for Disease Control and Prevention data sets, including natality data sets, fetal death data sets, and all-cause mortality data sets from 2016 to 2021. We limited analyses to Black or White individuals aged 15-44 years from 3,114 U.S. counties. Participants were categorized into quartiles based on county-level SVI. The primary outcome was maternal mortality rate while pregnant or within 42 days of the end of …


Microbial Remodeling Of Gut Tryptophan Metabolism And Indole-3-Lactate Production Regulate Epithelial Barrier Repair And Viral Suppression In Human And Simian Immunodeficiency Virus Infections, Clarissa Santos Rocha, Katie L. Alexander, Carolina Herrera, Mariana G. Weber, Irina Grishina, Lauren A. Hirao, Dylan J. Kramer, Juan Arredondo, Abigail Mende, Katti R. Crakes, Anne N. Fenton, Maria L. Marco, David A. Mills, John C. Kappes, Lesley E. Smythies, Paul Ziprin, Sumathi Sankaran-Walters, Phillip D. Smith, Satya Dandekar Jan 2025

Microbial Remodeling Of Gut Tryptophan Metabolism And Indole-3-Lactate Production Regulate Epithelial Barrier Repair And Viral Suppression In Human And Simian Immunodeficiency Virus Infections, Clarissa Santos Rocha, Katie L. Alexander, Carolina Herrera, Mariana G. Weber, Irina Grishina, Lauren A. Hirao, Dylan J. Kramer, Juan Arredondo, Abigail Mende, Katti R. Crakes, Anne N. Fenton, Maria L. Marco, David A. Mills, John C. Kappes, Lesley E. Smythies, Paul Ziprin, Sumathi Sankaran-Walters, Phillip D. Smith, Satya Dandekar

Department of Obstetrics & Gynecology Faculty Publications

Gut inflammatory diseases cause microbial dysbiosis. Human immunodeficiency virus-1 (HIV) infection disrupts intestinal integrity, subverts repair/renewal pathways, impairs mucosal immunity and propels microbial dysbiosis. However, microbial metabolic mechanisms driving repair mechanisms in virally inflamed gut are not well understood. We investigated the capability and mechanisms of gut microbes to restore epithelial barriers and mucosal immunity in virally inflamed gut by using a multipronged approach: an in vivo simian immunodeficiency virus (SIV)-infected nonhuman primate model of HIV/AIDS, ex vivo HIV-exposed human colorectal explants and primary human intestinal epithelial cells. SIV infection reprogrammed tryptophan (TRP) metabolism, increasing kynurenine catabolite levels that are …


Exposure To Phthalates And Replacements During Pregnancy In Association With Gestational Blood Pressure And Hypertensive Disorders Of Pregnancy, Erin E. Mcnell, Danielle R. Stevens, Barrett M. Welch, Emma M. Rosenthal, Suzanne Fenton, Antonia M. Calafat, Julianne Cook Botelho, Elena Sinkovskaya, Ann Przybylska, George Saade, Alfred Abuhamad, Kelly K. Ferguson Jan 2025

Exposure To Phthalates And Replacements During Pregnancy In Association With Gestational Blood Pressure And Hypertensive Disorders Of Pregnancy, Erin E. Mcnell, Danielle R. Stevens, Barrett M. Welch, Emma M. Rosenthal, Suzanne Fenton, Antonia M. Calafat, Julianne Cook Botelho, Elena Sinkovskaya, Ann Przybylska, George Saade, Alfred Abuhamad, Kelly K. Ferguson

Department of Obstetrics & Gynecology Faculty Publications

Exposure to endocrine-disrupting chemicals such as phthalates may increase risk of hypertensive disorders of pregnancy (HDP). Prior studies lack investigation of chemical mixtures, phthalate replacements, or key periods of susceptibility including early pregnancy. In the present study, we used a longitudinal approach to evaluate gestational exposure to phthalates and replacements, as both single-pollutants and mixtures, in association with blood pressure and diagnosis of preeclampsia or any HDP. The Human Placenta and Phthalates prospective pregnancy cohort includes 291 participants recruited from two U.S. clinics. Urinary metabolites of ten phthalates and replacements were quantified at up to 8 time points per individual …


Association Of Prenatal Exposure To Phthalates And Phenols With Adverse Pregnancy Outcomes, Misa Hayasaka, Diana Aboukhater, George Saade, Tetsuya Kawakita Jan 2025

Association Of Prenatal Exposure To Phthalates And Phenols With Adverse Pregnancy Outcomes, Misa Hayasaka, Diana Aboukhater, George Saade, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between prenatal exposures to phthalates and phenols and adverse pregnancy outcomes, including preterm birth (PTB), small-for-gestational-age (SGA) birth weight, and gestational diabetes mellitus (GDM).

METHODS:

This study analyzed data from the Environmental Influences on Child Health Outcomes consortium, which harmonized longitudinal data on more than 30,000 pregnancies and 57,000 children from 69 cohorts across the United States and Puerto Rico. Pregnancy outcomes included PTB, SGA, and GDM, identified from medical records or self-reports. Generalized estimating equations models with Poisson distribution and robust variance were used to estimate relative risks (RRs) and 95% CIs per interquartile …


Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade Jan 2025

Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between the level of maternity care access and maternal and pregnancy-related mortality.

METHODS:

This was a cross-sectional analysis of county-level data in the United States from January 2018 to December 2021. Using the level of maternity care access, we categorized counties into desert, low access, moderate access, and full access. The primary outcome of interest was maternal mortality rate per 100,000 live births. A secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences and adjusted incidence rate ratios were calculated for maternal mortality and pregnancy-related mortality with multivariable negative binomial mixed-effects …


Methodological And Clinical Concerns In The Study On Postpartum Hypertension Management, Takaki Tanamoto, Kyosuke Kamijo, Yusuke Tsutsumi, Tetsuya Kawakita Jan 2025

Methodological And Clinical Concerns In The Study On Postpartum Hypertension Management, Takaki Tanamoto, Kyosuke Kamijo, Yusuke Tsutsumi, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

[Introduction] We read with interest the recent study by Rosenfeld et al.¹ However, we have several clinical and methodological concerns about this study.¹

First, this study's propensity score matching (PSM) lacked key clinical confounders, including perinatal risk factors and the highest systolic/diastolic blood pressures. Smoking, alcohol use, and multifetal gestation, which influence blood pressure during pregnancy,²,³ potentially affect both primary and secondary outcomes. Additionally, the authors did not report standardized mean differences before and after PSM, which are essential for assessing balance.⁴


Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang Jan 2025

Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

Methods

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular …


Fy 2025 Annual Report, Tenncare (Program) Jan 2025

Fy 2025 Annual Report, Tenncare (Program)

Annual Reports

The pages of this report detail the design and operation of the TennCare program, including eligibility and enrollment information, overviews of the managed care network, budget figures and a summary of the reform initiatives that created the program Tennessee operates today. The report also highlights several notable accomplishments over the past year.


Association Between The Intensity Of Exercise In The First Trimester And Early Second Trimester And The Risk Of Gestational Diabetes, Takaki Tanamoto, Misa Hayasaka, Tetsuya Kawakita Jan 2025

Association Between The Intensity Of Exercise In The First Trimester And Early Second Trimester And The Risk Of Gestational Diabetes, Takaki Tanamoto, Misa Hayasaka, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

Although some studies show that exercise decreases the incidence of gestational diabetes mellitus (GDM), the optimal exercise intensity during pregnancy remains unclear. We examined GDM risk according to exercise intensity in pregnant individuals.

Methods

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers‐to‐Be (nuMoM2b), a prospective study enrolling nulliparous individuals in the first trimester. Participants with pregestational diabetes or delivery before 20 weeks were excluded. Exercise intensity during the first (6–13 weeks’ gestation) and early second (16–21 weeks’ gestation) trimesters was categorized by metabolic equivalent of task hours per week (MET‐hr/week) as none, low intensity (< 7.5), moderate intensity (7.5–14.9), or high intensity (≥ 15). The primary outcome was GDM; secondary outcomes included preeclampsia, gestational hypertension, preterm birth, small‐for‐gestational‐age birth, and stillbirth. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) were calculated using a generalized linear mixed‐effects model with a Poisson distribution and robust error variance, controlling for the random effects of individuals and potential confounders.

Results …


Longitudinal Assessment Of Intravillous Arterioles In Normal Pregnancy Using Superb Microvascular Imaging, R. Horgan, E. Sinkovskaya, G. Saade, E. Kalafat, A. Heeze, A. Abuhamad Jan 2025

Longitudinal Assessment Of Intravillous Arterioles In Normal Pregnancy Using Superb Microvascular Imaging, R. Horgan, E. Sinkovskaya, G. Saade, E. Kalafat, A. Heeze, A. Abuhamad

Department of Obstetrics & Gynecology Faculty Publications

Objective

To use superb microvascular imaging (SMI) to longitudinally evaluate blood flow in intravillous arterioles (IVA) in pregnancy, and to develop reference ranges for IVA pulsatility index (PI) and peak systolic velocity (PSV) from 12 to 38 weeks' gestation.

Methods

The data for this study were obtained from the National Institutes of Health-funded Human Placenta Project. Eligible for inclusion were women aged 18-35 years, with a body mass index of <  30 kg/m², without comorbidities, with a singleton pregnancy conceived spontaneously and a gestational age of ≤ 13 + 6 weeks. Exclusion criteria were maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation and delivery <  37 weeks. Each participant underwent eight ultrasound examinations during pregnancy. Using SMI technology, the total number of IVA identified was recorded in a sagittal placental section at the level of cord insertion. The PI and PSV were measured in a total of six IVA (two in the central portion of the placenta, two peripherally towards the uterine fundal portion and two peripherally towards the lower uterine segment). Umbilical artery (UA)-PI was also obtained. Multilevel regression models were used to create reference ranges for IVA-PI and IVA-PSV at 12-38 weeks' gestation.

Results

A total of 90 women fulfilled the study criteria. IVA-PI decreased throughout pregnancy from a mean ± SD of 1.04 ± 0.23 in the first trimester (at 12-13 weeks) …


Mobile Health Intervention Tools Promoting Hiv Pre-Exposure Prophylaxis Among Adolescent Girls And Young Women In Sub-Saharan Africa: Scoping Review, Alex Emilio Fischer, Homaira Hanif, Jacob B. Stocks, Aimee E. Rochelle, Karen Dominguez, Eliana Gabriela Armora Langoni, H. Luz Mcnaughton Reyes, Gustavo F. Doncel, Kathryn E. Muessig Jan 2025

Mobile Health Intervention Tools Promoting Hiv Pre-Exposure Prophylaxis Among Adolescent Girls And Young Women In Sub-Saharan Africa: Scoping Review, Alex Emilio Fischer, Homaira Hanif, Jacob B. Stocks, Aimee E. Rochelle, Karen Dominguez, Eliana Gabriela Armora Langoni, H. Luz Mcnaughton Reyes, Gustavo F. Doncel, Kathryn E. Muessig

Department of Obstetrics & Gynecology Faculty Publications

Background:

In 2022, 3100 adolescent girls and young women in sub-Saharan Africa experienced new HIV infections each week. HIV pre-exposure prophylaxis (PrEP) is effective at preventing HIV but has limited uptake and persistence. Mobile health (mHealth) interventions can improve medication adherence; however, their utility to improve PrEP adherence among adolescent girls and young women is not well established.

Objective:

This scoping review synthesizes evidence supporting mHealth for PrEP among adolescent girls and young women in sub-Saharan Africa and identifies strategies for further evaluation.

Methods:

We searched PubMed and Google Scholar databases, expert referrals, and reference lists using the following eligibility …