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A Nuclear Terrorism Scenario: Improvised Nuclear Weapons With 60%-Enriched Uranium, Matt Caplan

Faculty publications – Physics

In this work we show that approximately 60–70 kg of 60%-enriched uranium can be used to build a crude nuclear weapon with a kiloton yield. While too large to fit on a missile, such a weapon could be delivered by a shipping container. This analysis is motivated by the June 2025 Israeli and US attacks on Iran, especially the bombings of the nuclear facilities at Natanz, Fordow and Isfahan. The Iranian stockpile of approximately 440 kg of 60%-enriched uranium is, at the time of writing, inaccessible to IAEA inspectors and stored in secret. The rapid clandestine relocation of this material …

Diagnostic Accuracy Of Combined B-Mode Ultrasound, Color Doppler And Strain Elastography In Assessment Of Cervical And Axillary Lymph Nodes, Marwa Mostafa, Nihal M. Batouty, Amani Ezzat Mousa

Mansoura Medical Journal

Background: Lymphadenopathy is a common condition caused by many benign and malignant disorders; therefore, determining their nature is important in clinical setting. The objective of research is to assess diagnostic accuracy of B-mode ultrasound, color Doppler, and strain elastography in lymph nodes evaluation with pathological correlation and to determine cut-off value of strain ratio that differentiates benign from malignant nodes.

Methods: All patients underwent ultrasound examination, Doppler study and strain elastography in supine position using a high-frequency probe (6.2-12 MHz). Out of 80 enrolled patients, only 53 were subjected to biopsy from the lymph nodes, then their pathological results …

Short Term Outcome Of Endovenous Microwave Ablation For Treatment Of Small Saphenous Vein Incompetence: A Single Center Experience, Diaa M. Elawady, Mohamed Shetiwy, M Farag Kamel, Tamer Khafagy

Mansoura Medical Journal

Aim: To evaluate the effectiveness and safety of using Endovenous Microwave Ablation (EMA) to treat primary small saphenous vein (SSV) incompetence.

Methods: The study was conducted on consecutive limbs with primary SSV incompetence confirmed by Duplex study and had CEAP clinical class C2–C6, between February 2024 and July 2025 at a tertiary referral center. Patients were treated with EMA using the ECO Microwave System Co (Nanjing, China). Primary endpoint included technical success whereas secondary endpoints included post-procedural complications and VCSS changes.

Results: A total of 23 patients and 24 limbs were included. Technical success was achieved in all patients. During …

Balancing Nationalities In International Investment Law, Peter J. Spiro

Chicago Journal of International Law

How can you tell where someone is “from”?  Historically, an individual’s national identity was singular, starting with formal nationality. One’s national center of gravity was readily determinable. Not so today. Determining one’s primary national identification is no longer an easy thing in many cases. This is consequentially enabled by the growing acceptance of dual citizenship. One can openly identify as a formal member of more than one country in a way that was disfavored in the past.

International investment law, however, has not caught up to this reality. In an increasing number of international arbitrations, tribunals are shutting the doors …

The Territorial Independence Of Intellectual Property Rights, Aaron X. Fellmeth

Chicago Journal of International Law

No abstract provided.

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 …

Reducing Re-Hospitalizations Among Adult Residents In Skilled Nursing Facilities: A Guideline Project, Nicole Crooks

Doctor of Nursing Practice (DNP) Scholarly Projects

Purpose: This project aimed to develop an evidence-based guideline to support early recognition of clinical deterioration and improve communication among SNF staff, with the goal of reducing avoidable rehospitalizations, and to evaluate stakeholder perceptions of the proposed recommendations. Methods: A literature review was completed to develop eight recommendations that were used to create a guideline and toolkit for the SNF setting. Six stakeholders evaluated the recommendations on a 4-point scale. Ratings were analyzed using descriptive statistics and the Friedmans test. Results: Stakeholder ratings were favorable, with means ranging from 3.50 to 3.83. Recommendations 3 and 6 had the highest means …

Empowering Students To Engage With Climate Change Action: A Project-Based Module For Artificial Intelligence Literacy And Sustainability Thinking, Gabriel Granco, Yu Chen, Heather Macias, Yunfei Hou, Frank A. Gomez

Faculty Research, Scholarly, and Creative Activity

There is a growing need to prepare students to address complex environmental challenges, particularly climate change and the expanding role of artificial intelligence (AI). This article examines the adaptation of the Artificial Intelligence for Social Good (AI4SG) Ideation module, a pitch- and project-based teaching framework designed to integrate AI literacy and sustainability education. Implemented in an upper division climate change course, the module combines project-based learning, culturally responsive pedagogy, and geographic thinking to guide students in developing community-oriented AI proposals aligned with the United Nations Sustainable Development Goals (SDGs). Students were encouraged to approach their communities not through deficit lenses, …

Federal Protections For Farmworker Health In The United States: A Scoping Review Of Three Decades Of Research, Kaitlyn Alvarez Noli, Stephane Labossiere, Becca Berkey, Joseph G. Grzywacz

Faculty Research, Scholarly, and Creative Activity

Objectives: This scoping review characterizes the scope, methods, and framing of empirical research evaluating the Field Sanitation Standard (FSS) and Worker Protection Standard (WPS) of the U.S. Environmental Protection Agency and the U.S. Department of Labor respectively. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we identified empirical studies (1990–2024) assessing elements of either the FSS or WPS. Two reviewers screened and extracted study characteristics, designs, populations, and regulatory elements. Framing analysis of 1226 segments, identified using a large language model, from the studies' abstracts and introductions examined how authors conceptualized farmworkers' need for protection. …

Comparison Of Mental Illness Comorbidity Pre-Pandemic Vs. Pandemic-Era And Associations With Clinical And Demographic Characteristics For Virginia Public Hospital Inpatient Discharges With A Substance Use Disorder, Marilyn Bartholmae, Tharidu Gunawardena

Department of Medicine Faculty Publications

The rise in mental illnesses after the COVID-19 pandemic is well documented. However, it is not known whether the rates of mental illness comorbidity increased. The objectives of this study were to compare mental illness comorbidity rates before and after the pandemic among inpatients with SUD and to test associations between mental illness comorbidity, physical illness, and demographics. We used a retrospective cross-sectional design in a sample of inpatient discharges (N = 233,017) at Virginia public hospitals from January 2018 to December 2022. We used Z tests to compare rates of mental illness comorbidity pre- and post-pandemic and Chi-square tests …

Assessment Of Skin In Patients With Systematic 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

Department of Medicine Faculty 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, …

Criterion Validity Of The Functional Status And Pain Assessment Scale Versus Pain And Length Of Stay In Hospitalized Adults With Scd, Wally R. Smith, Daniel M. Sop, Yue May Zhang, Margaret S. Guy, Rehan Qayyum

Department of Medicine Faculty Publications

Objectives

In prior research we demonstrated face, construct, discriminant, and preliminary convergent validity of the newly developed, 10-item Functional Status Pain Assessment (FSPA) scale (0-50) in adult SCD patients hospitalized with VOC. We aimed in this study to further demonstrate criterion validity of the FSPA.

Methods

This was a prospective observational study of 561 daily functional and pain assessments from 91 hospitalized adults with SCD from January 2018 to June of 2019. Principal Component Analysis (PCA) Partial Least Squares (PLS) models determined the relationship between LOS, pain intensity, and FSPA. A Generalized Linear Model (GLM) to quantified the impact of …

Trends In Hypertension Prevalance And Control In The United States Over 25 Years, Omar Saleh, Neda Rehan, Saleh Mostafa, Rehan Qayyum

Department of Medicine Faculty Publications

Despite sustained public health efforts, hypertension remains highly prevalent in the United States, with persistent disparities across demographic and socioeconomic groups. We examined 25-year trends in hypertension prevalence, undiagnosed hypertension, and on-treatment uncontrolled hypertension in the United States using nationally representative National Health and Nutrition Examination Survey (NHANES) data from adults aged ≥18 years. Hypertension was defined as systolic BP ≥130 mmHg, diastolic BP ≥80 mmHg, or current antihypertensive use. Undiagnosed hypertension was defined as elevated BP without prior diagnosis or treatment, while on-treatment uncontrolled hypertension was defined as diagnosed hypertension with BP ≥130/80 mmHg despite treatment. Survey-weighted generalized linear …

Aggressive Natural Killer Cell Leukemia: A Rare And Rapidly Progressive Hematologic Malignancy—Case Report And Literature Review, Jennifer Priessnitz, Ali Hariri, Yuliya Levkiavska, Kyle E. Bonner, Stephan I. Fisher, Joshua M. Sill

Department of Medicine Faculty Publications

Aggressive natural killer cell leukemia (ANKL) is a rare, fulminant hematologic malignancy characterized by neoplastic proliferation of mature NK cells. It is frequently associated with Epstein-Barr virus (EBV) infection, although EBV-negative cases have also been reported. While typically observed in young to middle-aged adults of East Asian descent, increasing recognition has led to identification of ANKL across diverse age groups and ethnicities. The disease is defined by a rapid clinical course and poor prognosis, underscoring the importance of early diagnosis and effective treatment. We present a case of a 71-year-old Caucasian male who developed fever, altered mental status, hepatosplenomegaly, pancytopenia, …

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 …

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.

Comparing Pre-Occupational Therapy Student Intercultural Competence Through Local And Global Service Learning, Leah S. Dunn, Diane Ceo-Difrancesco

Journal of Occupational Therapy Education

This study examined undergraduate pre-occupational therapy student intercultural competence (ICC) development through a local or global service-learning experience. Using a mixed-method approach, responses to the Inventory for Assessing the Process of Cultural Competence among Healthcare Professions-Student Version (IAPCC-SV) were compared as well as a content analysis of student essays before and after the service-learning experience to determine ICC growth. Both groups demonstrated ICC growth, but global participants continued their development past the experience. Student essays revealed themes of dissonance, reflection, transformation, and advocacy, with local students focusing on clients and global students adopting broader advocacy goals. Immersive experiences in occupational …

How Do Students Come Across Occupational Therapy And What Makes Them Want To Study Occupational Therapy? Implications For Recruitment, Mette Eg Bruun, Mette Krohn, Sofie Balle Riis, Lene Tanggaard, Tina Helle

Journal of Occupational Therapy Education

Recruitment challenges in occupational therapy education vary globally. To address workforce needs, it is necessary to examine the factors influencing students’ decisions to pursue occupational therapy. This study investigated how students discovered occupational therapy, what they found appealing about the profession, the influence of study location, and demographic differences between students enrolled in an urban university city and a rural district. Three focus group interviews with 15 occupational therapy students were conducted, supplemented by descriptive statistics comparing student characteristics across urban and rural programs. Qualitative analysis identified five categories: (1) discovering occupational therapy by chance, (2) the power of occupational …

Balancing Acts: Exploring Chronic Illness’ Impact On Achievement In Graduate Health Education, Olivia J. Fulton, Lizeth S. Iboy, Bonnie Decker

Journal of Occupational Therapy Education

Graduate students with chronic illness encounter barriers as they navigate graduate programs to achieve their personal goals. Chronic illnesses are often invisible, which makes it more challenging to navigate the educational system. This study aimed to understand participants’ ability to engage in their academic environment and how the severity of their symptoms related to their diagnosis impacted participation in lectures, laboratory activities, exams, and competencies. Nineteen participants completed the online survey with questions regarding demographics and perception of how their condition impacted their academic performance on their best days versus worst days. Three assessment tools were incorporated into the survey: …

A Rasch Analysis Of The Self-Assessment Scale Of Clinical Reasoning In Occupational Therapy (Sa-Crot) For Continuing Professional Development, Sho Maruyama, Reiko Miyamoto, Takuya Hirose, Takao Kaneko, Peter Bontje

Journal of Occupational Therapy Education

The purpose of this study was to establish structural validity, internal reliability, and concurrent validity of the Self-Assessment scale of Clinical Reasoning in Occupational Therapy (SA-CROT) when used in continuing professional development. We conducted a cross-sectional survey of 513 occupational therapists with ≤5 years of experience. Rasch analysis was applied to assess structural validity (rating scale functioning, monotonicity, dimensionality, item/person fit) and reliability (item/person reliability, strata). Additionally, concurrent validity was examined by Spearman’s correlation with clinical experience. The Rasch rating scale analysis supported the structural validity of the SA-CROT. Categories showed ordered thresholds with outfit mean-square (MnSq) values ranging from …

From Classroom To Care: A Pilot Level I Fieldwork Experience Building Acute Care Self-Efficacy, Hannah Y. Oldenburg, Jennifer Bergstrom, Traci Kruse, Tamra Trenary, Corey Mcgee

Journal of Occupational Therapy Education

Level I fieldwork provides an opportunity for occupational therapy students to be exposed to the occupational therapy framework and process across various practice settings. This study addresses a gap in the literature regarding introductory fieldwork experiences for occupational therapy students in complex medical settings, specifically acute care. Researchers implemented a seven-week Level I fieldwork experience at two Midwest trauma centers, utilizing a mixed-methods, two-cohort design with 12 students and 16 practitioners. The program featured a blended Level I fieldwork supervision model, combining faculty-led and traditional on-site supervision. Over the seven-week period, students showed significant improvement in their perceived self-efficacy regarding …

Validity And Reliability Of The Professional Belonging Scale For Occupational Therapy Students Version 2, Sarah Corcoran Otd, Otr/L, Pooja Patel Drot, Otr/L, Izabela Dubiel Drot, Otr/L, Theresa Rhett-Davis Edd, Otr/L, Nancy Green Ms, Drot, Otr/L, Emily Pasqualetto Drot, Otr/L, Amanda Carter Drot, Otr/L

Journal of Occupational Therapy Education

A strong sense of belonging supports student engagement, motivation, clinical competency, retention, and overall well-being; yet few tools specifically assess this construct in occupational therapy (OT) and occupational therapy assistant (OTA) programs. To address this gap, Corcoran et al. (2025) developed the Professional Belonging Scale for Occupational Therapy Students (PBSOTSv1). The current study aimed to revise the PBSOTSv1 for clarity, inclusivity, and alignment with emerging theoretical frameworks and to evaluate the revised version (PBSOTSv2) for content validity and internal consistency reliability. Revisions involved expert cognitive interviews and Content Validity Index (CVI) ratings, guided by Allen et al.’s framework of belonging, …

Generative Artificial Intelligence Application In Occupational Therapy Education, James Wersal, Justin Mason, Mary Shotwell

Journal of Occupational Therapy Education

Generative artificial intelligence (GenAI) is a developing technology within Higher Education Institutions with substantial potential to transform teaching pedagogy, improve individualized learning experiences, and automate administrative functions. GenAI has the potential to bring significant enhancements by advancing adaptive learning interfaces, customized learning materials, and automate administrative support. Despite these benefits, ethical considerations, data privacy, and the risk of over-reliance should be considered prior to using GenAI. The authors highlight how GenAI is supported by adult learning theory and provide practical strategies for incorporating GenAI in the occupational therapy curricula and to support the faculty role. The impact of GenAI on …

The Psychosocial Occupational Therapy Competency Assessment, Revised- Pot-Ca(R), Jenna C. Yeager, Derek Piggott

Journal of Occupational Therapy Education

The Psychosocial Occupational Therapy Competency Assessment (POT-CA) was originally published in 2017 as a framework for assessing student development of foundational skills in evaluation, clinical reasoning, and therapeutic interactions in an occupational therapy psychosocial theory and practice course. The COVID-19 global pandemic necessitated the adaptation of this final student competency assessment for virtual administration. The Canadian Occupational Performance Measure (COPM) was selected as the performance-based element of the competency assessment in lieu of the previously required Allen Cognitive Level Screen (ACLS-5), which was unavailable to students due to pandemic restrictions. The purpose of this article is to present an analysis …