Digital Commons Network^™

Drug-Induced Leukocytoclastic Vasculitis From An Unreported Source: Daptomycin, Jennifer K. Priessnitz, Timothy Kuzel, Lindsay Ackerman, Nelson Nicolasora

Department of Medicine Faculty Publications

Leukocytoclastic vasculitis (LCV) is a rare small-vessel vasculitis caused by immune-complex-mediated deposition on endothelial cells of dermal capillaries. Common triggers include medications, infections, autoimmune disorders, and malignancies. We present a case of a 58-year-old male who developed daptomycin-induced LCV after being treated for Methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. The patient experienced painful palpable purpura on his lower extremities, which was diagnosed as LCV by skin biopsy. At the time of the biopsy, warfarin and daptomycin were discontinued, and the patient was transitioned to heparin and ceftaroline. MRSA-induced LCV was ruled out, due to negative blood cultures and adequate source control …

Treatment Of Myocardial Infiltration Of Hodgkins Lymphoma: A Catch-22, Jennifer Priessnitz, Erin Biringen, Fadi Khoury, Christina Bergin

Department of Medicine Faculty Publications

Background: Cardiac sequelae in Hodgkin Lymphoma (HL) can manifest as involvement of the heart and pericardium. Direct cardiac involvement is rare, and myocardial infiltration is distinctly unusual.¹ When it does occur, it is often a late manifestation of lymphoma, with a median onset of 20 months after initial diagnosis, and it is usually associated with advanced-stage disease.²

Case: A 34-year-old male was diagnosed with classic HL by lymph node biopsy. During his hospitalization, the patient remained in sinus tachycardia with heart rate up to 150 with no dysrhythmias. Transthoracic echocardiogram (TTE) revealed a reduced ejection fraction (EF) of 36% concerning …

Emergent Transcatheter Tricuspid Edge-To-Edge Repair For Right Ventricular Shock From Tricuspid Regurgitation In Hypertrophic Cardiomyopathy, Nicholas J. Valle, Amin Yehya, Animesh Rathore, Erich L. Kiehl, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Transcatheter tricuspid edge-to-edge repair (T-TEER) is an emerging technology used to treat severe tricuspid regurgitation (TR). The pivotal trials demonstrating the safety and efficacy of T-TEER exclude patients with severely reduced left ventricular function (≤20%).

Case Summary

We demonstrate the use of T-TEER in a patient with end-stage hypertrophic cardiomyopathy who suffered acute, torrential TR and subsequently developed cardiogenic shock as a complication of high-risk transvenous lead extraction. Why Beyond the Guidelines Currently, there are no guidelines addressing the nonsurgical emergent management of acute TR.

Discussion

The TriClip system (Abbott) may have certain advantages when used in managing acute …

The Timing For Primary Prevention For Icd In The Current Era Of Pharmacotherapy, Anastasia Shchendrygina, Amin Yehya, Hadi Skouri

Department of Medicine Faculty Publications

Recent advances in the pharmacological therapy of heart failure with reduced ejection fraction (HFrEF) have significantly impacted the overall survival, heart failure hospitalisations and rates of sudden cardiac death (SCD). In this context, the relevant timing of placing ICDs as primary prevention is a matter of on-going debate. This manuscript provides evidence for an updated view regarding the timing of implanting ICD in eligible patients with HFrEF receiving optimal guideline-directed medical therapy, accounting for the timing to reverse cardiac remodelling (RCR) occurrence and residual SCD risks over time. Clinically significant RCR occurs beyond 3 months of optimal guideline-directed medical therapy, …

Delayed Hypertension Diagnosis And Its Association With Cardiovascular Treatment And Outcomes, Yuan Lu, John E. Brush Jr, Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Jordan R. Asher, Harlan M. Krumholz

Department of Medicine Faculty Publications

Importance Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk.

Objectives To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes.

Design, Setting, and Participants This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, …

Balancing Regeneration And Resistance: Targeting Dclk1 To Mitigate Gastrointestinal Radiation Injury And Oncogenesis, Landon L. Moore, Jerry Jaboin, Milton L. Brown, Courtney W. Houchen

Department of Medicine Faculty Publications

Ionizing radiation (IR) poses a dual challenge in medicine; while essential for cancer therapy, it inflicts collateral damage to normal tissues, particularly the gastrointestinal (GI) tract. High-dose IR triggers acute radiation syndrome (ARS), characterized by crypt stem cell depletion, mucosal barrier disruption, inflammation, and potential progression to fibrosis and secondary malignancy. Emerging evidence identifies the epithelial kinase doublecortin-like kinase 1 (DCLK1)—highly expressed in GI tuft cells and cancer stem-like cells—as a master regulator of post-IR responses. DCLK1 integrates DNA repair (via p53/ATM), and survival signaling (via NF-κB, TGF-β, and MAPK) to promote epithelial regeneration, yet these same mechanisms contribute to …

Group Antenatal Care Positively Transforms The Care Experience: Results Of An Effectiveness Trial In Malawi, Crystal L. Patil, Kathleen F. Noor, Esnath Kapito, Li C. Liu, Xiaohan Mei, Elizabeth Chodzaza, Genesis Chorwe-Sungani, Ursula Kafuulafula, Elizabeth T. Abrams, Allissa Desloge, Ashley Gresh, Rohan D. Jeremiah, Dhruvi R. Patel, Anne Batchelder, Heidy Wang, Jocelyn Faydenko, Sharon S. Rising, Ellen Chirwa

Department of Medicine Faculty Publications

Background

We developed and tested a Centering-based group antenatal (ANC) model in Malawi, integrating health promotion for HIV prevention and mental health. We present effectiveness data and examine congruence with only the Group ANC theory of change model, which identifies key processes as supportive relationships, empowered partners in learning and care, and meaningful services, leading to better ANC experiences and outcomes.

Methods

We conducted a hybrid effectiveness-implementation trial at seven clinics in Blantyre District, Malawi, comparing outcomes for 1887 pregnant women randomly assigned to Group ANC or Individual ANC. Group effects on outcomes were summarized and evaluated using t-tests, Mann-Whitney, …

Left Ventricular Assist Device Destination Therapy: A Journey To Home And Beyond, Mian Z. Munir, Marissa C. Galicia-Castillo, Mia Achitoov, Amin Yehya

Department of Medicine Faculty Publications

[Case] Mr H is a 74-year-old man with history of end-stage heart failure (ESHF) secondary to hereditary transthyretin cardiac amyloidosis. Our patient underwent placement of a HeartMate II (Abbott) left ventricular assist device (LVAD) as destination therapy (DT) at an outside hospital and later came to us (Sentara Heart Hospital) for continued management because he resided in the area. Over a 2-year period, the patient experienced multiple hospital admissions for acute heart failure (HF) exacerbations, delirium, and recurrent low-flow alarms. During his last hospitalization, the palliative medicine team was consulted to facilitate goals-of-care discussions with the patient and his family, …

Navigating The Complexities In Gender-Diverse Counseling: Understanding The Interplay Of Gender Identity, Racial Inequities, Economic Marginalization, And Aging, C. Gerwe

Department of Medicine Faculty Publications

Gender-diverse individuals continue to face unique challenges in daily life, with intersecting identities related to race, socioeconomic status (SES), and age further compounding these barriers. These overlapping factors profoundly impact mental health and wellbeing, especially within environments that may lack inclusive or responsive frameworks. Despite increasing awareness, limited guidance exists for counselors on implementing practices that validate intersecting identities while addressing the cumulative effects of marginalization (Canvin et al., 2022). This article synthesizes current research and case examples to illuminate these challenges and offers insights for fostering more inclusive and supportive counseling approaches.

Changes In Cardiovascular Risk Factors And Health Care Expenditures Among Patients Prescribed Semaglutide, Yuan Lu, Yuntian Lu, Tedi Totojani, Chungsoo Kim, Rohan Khera, Hua Xu, John E. Brush Jr., Harlan M. Krumholtz, Jason Abaluck

Department of Medicine Faculty Publications

Importance Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated substantial weight reduction and cardiovascular benefits in clinical trials. However, its association with clinical outcomes and health care expenditures remains underexplored.

Objective To evaluate changes in cardiovascular risk factors and health care expenditures among patients prescribed semaglutide across multicenter cohorts.

Design, Setting, and Participants This retrospective cohort study included 23 522 adults (≥18 years) who received an initial semaglutide prescription between January 1, 2018, and January 1, 2025, at Sentara Healthcare and between January 1, 2018, and May 1, 2025, at Yale New Haven Health System.

Exposure The first prescription of …

Educational Case: Bullous Pemphigoid, Ryan C. Saal, Alice A. Roberts, Richard M. Conran

Department of Medicine Faculty Publications

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see https://www.academicpathologyjournal.org/pcme.1

Arthroscopic Inlay Biceps Tenodesis Using A Tendon-Docking Anchor, Mark G. Soliman, Katherine S. Worcester M.S., Thomas E. Herron, Kevin F. Bonner

Department of Medicine Faculty Publications

Pathology of the long head of the biceps tendon can be treated surgically with a multitude of tenodesis techniques; however, there is a lack of consensus on which technique provides the most optimal outcomes. Commonly used methods include inlay tenodesis with a bone tunnel and interference screw construct and onlay tenodesis with anchors or unicortical buttons. Although current methods typically provide satisfactory outcomes, many surgeons believe complications and failure rates remain suboptimal across techniques. In this article, we present an arthroscopic suprapectoral biceps tenodesis technique using an anchor device that was developed to address the shortcomings of current techniques, optimize …

Cultures For Acid-Fast Bacilli: Are We Being Good Stewards?, Jennifer Hanrahan, Julie D. Sill, Patricia Ver Schneider, Jessica F. Copeland, Elsie Frimpongmaa Amoako-Kissi, Ogochukwu O. Ilobi, Angela J. Toepp

Department of Medicine Faculty Publications

Objective: To describe the use of cultures for acid-fast bacilli (AFB) and situations in which AFB cultures are unlikely to be of clinical benefit.

Design: Retrospective descriptive study of AFB cultures submitted to Sentara Health microbiology laboratory from December 1, 2021, to December 1, 2023. Data were collected from the electronic medical record and included patient demographics, the service line that ordered the culture, specimen source, and culture results.

Setting: Sentara Healthcare System.

Patients: All patients who had specimens submitted to the microbiology laboratory during the study period were included.

Results: A total of 13,944 AFB cultures from 8,243 …

Preliminary Validity Of A Daily Functional Status Pain Assessment Tool, Wally R. Smith, Rehan Qayyum, Alexandra Ulbing, Margaret S. Guy, Daniel M. Sop, Yue May Zhang

Department of Medicine Faculty Publications

Objectives: Readiness for discharge for a sickle cell disease vaso-occlusive crisis is dictated by factors far beyond pain control, including physical function/activity. We therefore designed and tested a functional status-based pain assessment questionnaire in SCD patients hospitalized with vaso-occlusive crises.

Methods: Sickle cell disease patients on a preselected nursing unit rated 10 draft Functional status-Based Pain Assessment items of activities of daily living on a 5 point Likert scale (0-5) from “very easy” to “very difficult” daily on each day of their admission until discharge, at approximately the same time. Concurrently, they reported Numeric Rating Scale (0-10) pain intensity. …

Patient-Self Inflicted Lung Injury (P-Sili): An Insight Into The Pathophysiology Of Lung Injury And Management, Himanshu Deshwal, Ahmed Elkhapery, Rudra Ramanathan, Deepak Nair, Isha Singh, Ankur Sinha, Rishik Vashisht, Vikramjit Mukherjee

Department of Medicine Faculty Publications

Acute respiratory distress syndrome (ARDS) is a heterogeneous group of disease entities that are associated with acute hypoxic respiratory failure and significant morbidity and mortality. With a better understanding and phenotyping of lung injury, novel pathophysiologic mechanisms demonstrate the impact of a patient’s excessive spontaneous breathing effort on perpetuating lung injury. Patient self-inflicted lung injury (P-SILI) is a recently identified phenomenon that delves into the impact of spontaneous breathing on respiratory mechanics in patients with lung injury. While the studies are hypothesis-generating and have been demonstrated in animal and human studies, further clinical trials are needed to identify its impact …

Fiber Photometry Analysis Of Spontaneous Dopamine Signals: The Z-Scored Data Are Not The Data, Conner W. Wallace, Clare Y. Slinkard, Rachael Shaughnessy, Katherine M. Holleran, Samuel W. Centanni, Christopher C. Lapish, Sara R. Jones

Department of Medicine Faculty Publications

Fluorescent sensors have revolutionized the measurement of molecules in the brain, and the dLight dopamine sensor has been used extensively to examine reward- and cue-evoked dopamine release, but only recently has the field turned its attention to spontaneous release events. Analysis of spontaneous events typically requires evaluation of hundreds of events over minutes to hours, and the most common method of analysis, z-scoring, was not designed for this purpose. Here, we compare the accuracy and reliability of three different analysis methods to identify pharmacologically induced changes in dopamine release and uptake in freely moving C57BL/6J mice. The D1-like receptor antagonist …

The Effect Of Inelastic Compression Wraps On The Quality Of Life Of People With Chronic Venous Insufficiency: A Single-Center, Single-Arm Prospective Study, Abby Hargis Smits, Marita Yaghi, Narges Maskan Bermudez, Hadar Lev-Tov

Department of Medicine Faculty Publications

Background/Objectives: First line therapy for all manifestations of chronic venous insufficiency (CVI) is compression. However, patients frequently report dissatisfaction with compression stockings. Therefore, there is a need to find alternative therapeutic options that can promote compliance. Here, we investigate the impact of the novel, inelastic compression wrap device on quality of life (QoL) in patients with CVI who have failed therapy with compression stockings in the past. Methods: We conducted a six-week, open-label, single-center, non-blinded, prospective cohort study. The primary endpoint was the change in QoL over 6 weeks as measured by the Chronic Venous Disease Quality of Life Questionnaire …

Dance-Related Fractures Occur In The Upper And Lower Extremities At Similar Rates: An Analysis Of The 2004-2023 National Electronic Injury Surveillance System Database, Senah E. Stephens, Joshua F. Edwards, Lisa K. Cannada

Department of Medicine Faculty Publications

Introduction

In the United States, 21% of adolescents participate in dance. Dancers are susceptible to injuries, particularly of the lower extremity, due to extreme positioning, dynamic overload, and repetitive movements.

Objectives

(1) to report the prevalence and describe demographic characteristics of dance-related fractures and (2) to analyze variables associated with disposition status.

Methods

The National Electronic Injury Surveillance System (NEISS) database, published by the US Consumer Product Safety Commission, was used to investigate dance-related fractures diagnosed in a sample of 100 emergency departments over 20 years. Descriptive statistics and demographic variables were analyzed using chi square tests. Age was analyzed …

Forming Of Economies Of Wellbeing Through Responsive Practice In Everyday Life, Julie Richardson

School of Art, Design and Architecture Theses

In recent years, most Western economies have increasingly focused on the narrow pursuit of economic growth with its unintended and undesirable impacts on the wellbeing of people and planet being well-documented. This has led to the growth in ‘alternative economics’ that addresses these critiques and proposes new economic models. However, alongside these critiques, there is another that questions the modern scientific approach underpinning economics, arguing that it overlooks the importance of lived experience, creating feelings of detachment in the economic practitioner as well as undermining the relevance and effectiveness of economics and policy making. The research develops a more responsive …

Affective Belongings And Remediating Practices: Visualising Imperial Formations And Unlearning Whiteness In Relation To British Immigration In So-Called Australia., Sian Gouldstone

School of Art, Design and Architecture Theses

In so-called Australia, the legacies of British colonialism remain unsettled and unresolved, socially, politically and culturally. This thesis consists of a written and practice element that together explore whiteness and photography, and the ways they create and sustain affective atmospheres of imperial duress in suburban Naarm (Melbourne). The origins of this enquiry lie in my family histories of immigration and personal encounters with Australianness and Britishness. From these experiences, I identify a personal, nostalgic, cryptic and mythological sense of belonging. Thus, I explore the critical spaces where nostalgia, belonging and whiteness overlap using digital photographic experimentations. My practices think through …

And The Skylarks Called Out Your Name: Posthuman Encounters With Loss Through Embracing The More-Than-Human World., Jennifer-Anne Bradbury-Crowther

School of Art, Design and Architecture Theses

Howling at the sea, tears in damp morning air, songs on the wind, syrup-thick summer warmth, dawn before midnight, red moon, humming, whispers. Meet me where the sky meets the sea. This thesis proposes that immersion in the more-than-human world offers possibilities for an exploration of loss and its transformative potential. Loss here not only relates to personal bereavement, but also to a lack of connection with the natural world; in these post-Covid days many are feeling overwhelmed by feelings of isolation and alienation and a sense that something intrinsic has been lost in the modern world.Posthumanism creates a supportive …

Visual Thinking Informed By Repetition: A Practice-Based Methodology, Julia Heurling

School of Art, Design and Architecture Theses

This artistic research proceeds from the idea that visual thinking is thinking about images through images. It explores how ideas are instigated, developed, and articulated exclusively through visual elements from a practice-based perspective. The use of repetition as a method of thinking is rooted in my previous practice as a pattern designer. I consider this a cognitive process based on the assumption that repetition is a tool for abstraction, as it changes one’s perspective from the particular to the general. Abstraction, in this context, becomes a method for processing information (i.e. to think visually).My artistic practice is engaged in combining …

Creative Psychotherapy, Including Art. A Module For Pluralistic Identities And A Case Study From An Artist's Perspective., Amani Alsaad

School of Art, Design and Architecture Theses

This thesis investigates the complexities of pluralistic identities, focusing on Arab Muslims in non-Muslim countries and Westerners residing in the Arabian Gulf. Grounded in the author’s dual heritage as an Arab Muslim artist and psychological practitioner, this study offers a distinctive perspective informed by lived experience. The author’s unique background, shaped by a Saudi Arabian birthplace and upbringing in the United Kingdom, serves as a foundation for this multidisciplinary research.The study aims to develop a creative psychotherapy module integrating art-making as a therapeutic technique to address the mental health challenges faced by individuals with pluralistic identities. These challenges, arising from …

Mesotopia: Towards A Place Of Lyrical Inquiry, Tristan Verran

School of Art, Design and Architecture Theses

This research project is a comprehensive investigation into the practical applications of a theoretical place of creative intuition I have called ‘the mesotopia’. A mesotopia is a place between conceptual and physical terrains in which inter-object experiential encounters are turned into communicative events. Mesotopian thinking unsettles purely anthropocentric utopian or dystopian future visions, as well as romantic images of Arcadian pasts. I have been attending to the material present of our coastal regions while attempting to intuit, rather than imagine, concealed aspects of these compositional sites. This thesis argues that attending to local environments using a more embodied form of …

Improving Quality Of Life Through Smart Public Transport: The Interplay Of Technological And Non-Technological Approaches In London And Tehran, Shadab Bahreini

School of Art, Design and Architecture Theses

Transportation plays a significant role in shaping quality of life in cities, affecting physical and mental health, socio-economic dynamics, and environmental sustainability. Traffic congestion and air pollution – common consequences of urban traffic – exacerbate these concerns, underscoring the importance of promoting public transport as an environmentally friendly alternative to private vehicle usage. Enhancing the quality of public transportation not only helps retain current users, but also attracts new passengers, ultimately reducing personal car use and its adverse effects in cities. While smart technologies offer opportunities to improve public transport by enhancing comfort, reliability, safety, accessibility, and affordability, the integration …

Ontological Machines: Subjectivity And Relational Desire In Immersive And Interactive Environments, Toby Chanter

School of Art, Design and Architecture Theses

This practice-based artistic research focuses on two contemporary spaces; namely the pedagogical spaces of healthcare Simulation Based Education (SBE), and the exhibition spaces of installation art. These seemingly unrelated activities share a range of technological and operational similarities that render their combined study under the banner of ‘immersive and interactive environments’ both novel and necessary. The lack of broad engagement with questions of representation, aesthetics, and affect is conspicuous in an educational practice that is reliant on, and implemented through, a network of overtly visual mediums, material technologies, and sensory modalities. In healthcare SBE, clinical skills are acquired, and medical …

Grassroots Playwriting : Practice-Led Research Exploring The Impact Of Producing Historical Verse Drama For A Local Community, Chris Savery

School of Art, Design and Architecture Theses

Christ SaveryGrassroots Playwriting: Practice-led research exploring the Impact of Producing Historical Verse Drama for a local CommunityOver the past thirty years, Practice as Research has contributed to a deeper understanding of theatre ecology, particularly in relation to the complexities and nuances of grassroots community theatre. This study builds upon this body of knowledge by addressing the question: How can the creation and performance of a historical verse drama by a self-producing grassroots playwright serve as a catalyst for community engagement? Central to this thesis is the investigation into my role as a self-producing playwright within the context of grassroots theatre, …

Above And Below The Horizon: A Practice-Led Investigation Into Liminal Thresholds Of Bodies Of Water, Rachael Allain

School of Art, Design and Architecture Theses

This thesis contributes to the debate on the interactions between art, science, and phenomenological experience, whilst offering new possibilities for investigation in this interdisciplinary field. The research investigated thresholds of the aquatic horizon; the outline in the distance where sky and water appear to coalesce. Artistic practice and critical discourse challenged and interrogated the intersection between analogue and digital, still and moving technologies, revealing aspects of the physical and conceptual horizons within and beyond the visible light spectrum. A range of theoretical concepts reconfigured my readings and interpretations of the phases of experience, through liminality and phenomenology. This provided a …

Zen And The Art Of Praxis: New Adventures In Live Coding, Quantum Computing, And The Web., Peter Thomas

School of Art, Design and Architecture Theses

In recent years, quantum computing has emerged from the realm of science fiction, becoming a real-world discipline with practical applications. Although NISQ-era hardware imposes significant limitations, and the case for quantum advantage over classical algorithms remains largely theoretical, its potential is being increasingly embraced by the arts; a domain where the merit of exploring new terrain may outweigh the need for technical precision. In particular, quantum computer music has evolved from its origins as a branch of unconventional computing, to an established practice with a growing global community of composers, performers, and researchers. However, the available tools remain largely experimental: …

Opening Spaces For The Emergence Of Community Economy Initiatives, Timothy Crabtree

School of Art, Design and Architecture Theses

The background to the thesis is the crisis of affordable housing in the UK, and the emergence of community housing initiatives as a response. There are enabling organisations which provide support, but despite an increasing recognition of the contribution that housing makes to carbon emissions, affordability rather than sustainability remains the primary focus. In particular, the use of natural materials with low embodied carbon is often dismissed as unaffordable. The thesis therefore explores how a community housing enabling organisation might reconcile the apparently conflicting aims of affordability and sustainability. There is a gap in research into this area, in particular …