Digital Commons Network^™

The Paradox Of Continuing Risk, W. Jonathan Cardi, Ashton Jenne, Chance Villarreal

American University Law Review

The continuing-risk rule is ubiquitously cited by Restatements, casebooks, and treatises as a core duty rule in negligence cases. Indeed, as this Article reveals, the rule has been “adopted”—in the sense that at least one court in a jurisdiction has applied the rule, and no court has rejected it—in thirty-one jurisdictions. In addition to the breadth of its adoption, the continuing-risk rule is also far-reaching: it imposes an affirmative duty to warn, protect, or rescue another from a risk if the defendant’s conduct contributed to the initial creation of that risk. Because most negligence cases involve risk-creating conduct by the …

An Unusual Case Of Gastrointestinal Bleeding In A Recent Roux-En-Y Patient, Christopher J Carnabatu, Tanyaradzwa M Kajese, Erik B Wilson

Faculty, Staff and Student Publications

The incidence of obesity nationwide has led to an increase in both medicinal and surgical interventions, with recent studies indicating a drop in obesity prevalence for the first time in over a decade. Laparoscopic Roux-en-Y gastric bypass remains one of the most commonly performed bariatric procedures in the United States, accounting for about 22% of all bariatric surgeries in 2022. While considered a safe procedure, gastric bypass results in an anatomic configuration that poses a unique challenge from both a surveillance and interventional standpoint. The gastric remnant, biliopancreatic (BP) limb, and extrahepatic biliary tree are not readily accessible vis-à-vis esophagogastroduodenoscopy …

Palliative Care In Acute Care Surgery: Research Challenges And Opportunities, Amelia W Maiga, Vanessa Ho, Rachel S Morris, Lisa M Kodadek, Thaddeus J Puzio, Gail T Tominaga, Masami Tabata-Kelly, Zara Cooper

Faculty, Staff and Student Publications

Palliative care includes effective communication, relief of suffering and symptom management with an underlying goal of improving the quality of life for patients with serious illness and their families. Best practice palliative care is delivered in parallel with life-sustaining or life-prolonging care. Palliative care affirms life and regards death as a normal process, intends neither to hasten death nor to postpone death and includes but is not limited to end-of-life care. Palliative care encompasses both primary palliative care (which can and should be incorporated into the practice of acute care surgery) and specialty palliative care (consultation with a fellowship-trained palliative …

Latent Classes Of Adolescent Trauma Exposure, Posttraumatic Stress Disorder Symptoms, And Substance Use Predict Clinical Diagnoses At 12-Month Follow-Up, John Leri, Josh M Cisler, Shaunna L Clark, Cody G Dodd, Saman Siddiqui, Leslie Taylor, Alexa Ayala, Sunita Stewart, Robyn Richmond, Jeffrey D Shahidullah, Justin F Rousseau, John M Hettema, D Jeffrey Newport, Karen D Wagner, Charles B Nemeroff

Faculty, Staff and Student Publications

BACKGROUND: Trauma exposure, posttraumatic stress disorder (PTSD), and substance use commonly co-occur among youth. Identifying specific subgroups of youth based on unique constellations across these domains may provide a novel way to identify and target youth at prospective risk for specific types of negative clinical outcomes.

METHODS: Trauma exposed youth completed structured clinical assessments as part of a longitudinal study (

RESULTS: Four latent classes were identified which differentiated participants based on the type of trauma exposure, the number of PTSD symptoms endorsed, and the propensity to be engaged in polysubstance use. Latent classes which were characterized by exposure to …

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

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 …

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 …

Real-World Interventional Outcomes For Cardiogenic Shock Complicating Acute Myocardial Infarction, John E. Brush Jr., Ann M. Harper, Luke C. Kohan, Zachary Bouker, Kaivalya Dandamudi, Deepak R. Talreja

Department of Medicine Faculty Publications

Acute myocardial infarction with cardiogenic shock (AMICS) carries high mortality and remains a major concern. This concern drives use of interventions with marginal benefit and some evidence of harm. The configuration of hospital care and allocation of interventions for AMICS in our health system created a natural experiment to analyze interventional outcomes for patients with AMICS.

Objective

To compare clinical outcomes among AMICS patients treated with mechanical circulatory support (MCS) using a micro-axial left ventricular assist device and intra-aortic balloon counter-pulsation (IABP).

Design, setting, participants, outcome measures

In this observational study in a large health system, we used clinical registry …

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 …

Psychedelic Minimalism: The Case Against Music In Psychedelic Therapy Settings, Samir A. Nader

Department of Medicine Faculty Publications

[Introduction: reframing the role of setting] In recent years, renewed attention has been given to the centrality of set and setting in psychedelic-assisted therapy. The Reporting of Setting in Psychedelic Clinical Trials (ReSPCT) guidelines reflect an evolving consensus: therapeutic outcomes are not solely pharmacologically determined but are heavily shaped by both the environment and the psychological state of the participant (2). Within this evolving paradigm, music has assumed a privileged role, framed as a therapeutic constant, typically curated to be emotionally supportive or evocative, and especially emphasized during peak psychedelic states (3). The prevailing assumption is that music facilitates safety, …

A Case Displaying The Importance Of Jak1 And Jak2 Gene Transcription In Antifungal Defense Against Coccidioidomycosis, Jennifer K. Priessnitz, Taylor Colore, Nelson Nicolasora

Department of Medicine Faculty Publications

This case report explores the consequences of ruxolitinib via inhibition janus kinase 1 (JAK1) and JAK2 pathways in the context of fungal defense in a patient diagnosed with pulmonary coccidioidomycosis during ruxolitinib therapy for polycythemia vera. The patient experienced a relapse of pulmonary coccidioidomycosis after antifungal treatment was discontinued while continuing ruxolitinib use. This case illustrates the heightened risk of discontinuing antifungal therapy in endemic regions, emphasizing the critical need for continued monitoring. Furthermore, this case underscores the vital role of the JAK1 and JAK2 signaling cascade, particularly the interferon-gamma (INF-γ)-JAK1 and JAK2-signal transducer and activator of transcription 1 (STAT) …

Oral Microbiome And Inflammatory Bowel Disease: New Understanding And Call To Action, Michael Saadeh, Sydney Donohue, Shaina Ailawadi, Gordon Hong, David A. Johnson

Department of Medicine Faculty Publications

The oral microbiome is the second largest microbial community in the human body after the gut microbiome. It includes an array of fungi, bacteria, amoebae, flagellates, archaea, and viruses, all of which are potential pathogens. This microbiome can act as a facilitator not only for protection but also for aggravation when dysbiosis occurs. Although conventional thought is this is primarily in terms of oral health issues, such as dental caries and gingival disease. The systemic effects of the oral microbiome however, are relevant to both gastrointestinal (GI) disease and non-GI disease. These systemic risks occur for several reasons, including upregulation …

Medical Students' Attitudes Towards Research Participation After The United States Medical Licensing Examination Step 1 Scoring Change, Danxun Li, Nina Li, Curt Bay, Uzoma Ikonne

Department of Medicine Faculty Publications

Background

The recent transition of scoring for the United States Medical Licensing Examination (USMLE) Step 1 exam from a numerical grading system to pass/fail system has significant implications for residency applicants. It is anticipated that research productivity will gain greater importance in the evaluation process. To understand how medical institutions can best support students, we seek to understand medical students' motivations and experience conducting research in medical school after the USMLE Step 1 scoring change.

Methods

This is a mixed-methods, cross-sectional study that examines the motivations and barriers that medical students face in conducting academic or clinical research. A survey …

The Urgent Need For Well-Being Programs In Medical Residencies In Brazil, Marcelo Bruno Generoso, Pedro Shiozawa, Ricardo Uchida, Marsal Sanches

Faculty, Staff and Student Publications

No abstract provided.

A Prior-Knowledge-Guided Feature Selection Method And Its Application To Biomarker Identification Of Schizophrenia, Ying Xing, Godfrey D Pearlson, Peter Kochunov, Vince D Calhoun, Yuhui Du

Faculty, Staff and Student Publications

Despite considerable efforts to uncover the neural basis of psychiatric disorders using neuroimaging, few methods utilize intrinsic brain-derived knowledge, leading to limited specificity and discriminability in biomarker identification. To leverage the inherent characteristics within the brain, we propose a prior-knowledge-guided feature selection method to flexibly unveil discriminative and target-oriented biomarkers of psychiatric disorders. Specifically, we construct a constrained sparse regularization allowing for the flexible integration of diverse prior knowledge to identify sparse neuroimaging features linked to specific psychopathology. Additionally, we simultaneously integrate graph-based regularization and redundancy-removal regularization to further ensure the discriminability and independence among the selected features. Different priors …

Brazilian Psychiatric Association Guidelines For The Treatment Of Social Anxiety Disorder, Leonardo Baldaçara, Thales Marcon Almeida, Diogo Cesar Dos Santos, Ana Beatriz Paschoal, Aldo Felipe Pinto, Luiz Antonio Vesco Gaiotto, Diogo De Lacerda Veiga, Fabiano Franca Loureiro, Leandro Fernandes Malloy-Diniz, Roseli Lage De Oliveira, Quirino Cordeiro, Marsal Sanches, Antônio E Nardi, Antônio Geraldo Da Silva, Ricardo R Uchida

Faculty, Staff and Student Publications

Social anxiety disorder (SAD), one of the most prevalent anxiety disorders, is not well recognized. In most cases, SAD follows an unremitted and chronic course, affecting individual functioning in relationships, education, and work. Due to the disorder’s relevance in Brazil, guideline-based treatments adapted to the Brazilian social and economic context are needed. We conducted a systematic review assessing several treatment modalities for SAD. PubMed, Cochrane, SciELO, and ClinicalTrials.gov were searched using the Medical Subject Headings social anxiety disorder and social phobia. Of the 438 selected articles, 20 were selected. Selective serotonin reuptake inhibitors are considered a first-line treatment for SAD …

Examining The Relationship Between Cardiometabolic Risk Factors And Telomere Length In Women: A Systematic Review, Jeni Page, Catherine Stephens, Melissa A Richard, Elizabeth Lyons, Elizabeth Baumler, M Terese Verklan, Elizabeth Lorenzo

Faculty, Staff and Student Publications

Background and objectives: Cardiometabolic syndrome (CMS) poses a significant public health challenge due to its rising prevalence in aging and significant healthcare costs. Recent studies have suggested telomere length (TL), a marker of cellular aging, may be impacted by CMS among women, but comprehensive evidence remains limited. This study aimed to examine the association between CMS risk factors (increased waist circumference [WC], elevated blood pressure, impaired fasting blood glucose, elevated triglycerides, decreased high-density lipoproteins) and TL in women, with consideration of age and race or ethnicity.

Research design and methods: A systematic review was conducted following PRISMA guidelines, with searches …

Mental Health Outcomes Of Latino Emerging Adults With Autism Spectrum Disorder In A Community-Based, Transition To Adulthood Program, Antonio F Pagán, Ana C Ramirez, Katherine A Loveland, Cecilia Montiel-Nava, Ron Acierno

Faculty, Staff and Student Publications

Latino individuals with autism spectrum disorder (ASD) face unique challenges during their transition to adulthood. This study evaluates ¡Iniciando! la Adultez, a culturally adapted behavioral health program aimed at addressing the co-occurring mental health needs of Latino young adults with ASD and their families. The program integrates culturally relevant elements to enhance engagement and effectiveness. Results indicated that the behavioral health intervention was associated with significant reductions in anxiety and depressive symptoms, highlighting the urgent need for tailored behavioral health services in this population. Additionally, the involvement of parents in group therapy demonstrated a positive impact on both parental and …

Consistent Frontal-Limbic-Occipital Connections In Distinguishing Treatment-Resistant And Non-Treatment-Resistant Schizophrenia, Yijie Zhang, Shuzhan Gao, Chuang Liang, Juan Bustillo, Peter Kochunov, Jessica A Turner, Vince D Calhoun, Lei Wu, Zening Fu, Rongtao Jiang, Daoqiang Zhang, Jing Jiang, Fan Wu, Ting Peng, Xijia Xu, Shile Qi

Faculty, Staff and Student Publications

Background and hypothesis: Treatment-resistant schizophrenia (TR-SZ) and non-treatment-resistant schizophrenia (NTR-SZ) lack specific biomarkers to distinguish from each other. This investigation aims to identify consistent dysfunctional brain connections with different atlases, multiple feature selection strategies, and several classifiers in distinguishing TR-SZ and NTR-SZ.

Study design: 55 TR-SZs, 239 NTR-SZs, and 87 healthy controls (HCs) were recruited from the Affiliated Brain Hospital of Nanjing Medical University. Resting-state functional connection (FC) matrices were constructed from automated anatomical labeling (AAL), Yeo-Networks (YEO) and Brainnetome (BNA) atlases. Two feature selection methods (Select From Model and Recursive Feature Elimination) and four classifiers (Adaptive Boost, Bernoulli Naïve …

Detection Of Erg11 Gene Mutation In Coding And Non-Coding Regions Of Clinical Candida Glabrata (Nakaseomyces Glabratus) Isolates From Pakistan, Saba Memon, Najia Karim Ghanchi, Urooj Zafar, Joveria Farooqi, Sadaf Zaka, Kauser Jabeen

Faculty, Staff and Student Publications

Azoles inhibit the cytochrome P450-dependent enzyme lanosterol 14α-demethylase (CYP51) that is encoded by the ERG11 gene. Azole resistance in Candida species arises through different mechanisms, like mutations in the ERG11 gene, ERG11 overexpression, CDR1,2 (Candida drug resistance) overexpression that actively efflux azole drugs, reducing their intracellular concentration and therapeutic effectiveness, and biofilm formation. We sequenced the ERG11 gene to determine mutations in the coding and non-coding regions of ERG11 in clinical isolates of Candida glabrata (Nakaseomyces glabratus) from Pakistan. Eight C. glabrata (N. glabratus) strains from our fungal strain bank (five fluconazole-resistant and …

Peer Support During In Vivo Exposure Homework Increases Likelihood Of Prolonged Exposure Therapy Completion, Melba A Hernandez-Tejada, Madeline J Bruce, Wendy Muzzy, Anna Birks, Giovanni Macedo E Cordeiro, Stephanie M Hart, Stephanie Hamski, Ron Acierno

Faculty, Staff and Student Publications

Exposure-based treatments such as prolonged exposure therapy (PE) are effective for veterans with PTSD. However, dropout rates as high as 50% are common. The Department of Veterans Affairs employs peers to increase mental health treatment engagement, however peers are not routinely used to help patients complete PE homework assignments. The present study included 109 veterans who decided to drop out from exposure-based treatment after completing seven or fewer sessions and used a randomized controlled design to compare PE treatment completion rates in response to 2 forms of peer support: (1) standard weekly telephone-based peer support vs. (2) peer-assisted in vivo …

Therapeutic Alliance In A Culturally Tailored Transition Program For Latino Young Adults With Autism And Their Families, Antonio F Pagán, Katherine A Loveland, Ron Acierno

Faculty, Staff and Student Publications

Latino young adults with autism spectrum disorder (ASD) often face barriers to accessing culturally appropriate interventions that support adaptive functioning and family dynamics. Therapeutic alliance, the collaborative and trusting relationship between participants and providers, is a critical component of intervention success, yet its role in culturally tailored programs for Latino families remains underexplored. The present study examined therapeutic alliance in ¡Iniciando! la Adultez, a 12-week, culturally adapted intervention for Latino young adults with ASD and their Spanish-speaking parents. The program integrates Latino cultural values and language and consists of parent group therapy, young adult group therapy, and individual therapy sessions. …

From Shocks To Solidarity And Superstition: Exploring The Foundations Of Faith, Aidin Hajikhameneh, Laurence R. Iannaccone

Faculty Research, Scholarly, and Creative Activity

Additive shocks can substantially increase cooperation in otherwise standard public goods game experiments. We study shocks that randomly adjust players’ earnings by a fixed positive or negative amount reported at the end of each round. These adjustments change neither the return to players’ contributions nor the information about other group members. We compare results across four treatments that employ the same group-level adjustment algorithm but frame it differently, with pre-play descriptions that range from omitting all useful information to accurately revealing its 50/50 random nature. In each treatment, overall contributions run about 50% higher than those obtained in the standard …

The Warrant Exception That Isn't Fisa Section 702, "Defensive" Searches, And The Fourth Amendment, Noah C. Chauvin

American University Law Review

Section 702 of the Foreign Intelligence Surveillance Act allows the government to conduct warrantless electronic surveillance of non-Americans who are located overseas. Although the surveillance targets foreigners, Americans’ communications are “incidentally” collected, too. Once the government has acquired Americans’ communications, court-approved rules allow it to conduct warrantless searches for and through them in its Section 702 databases. Intelligence agencies have used these rules to turn this foreign intelligence program into a domestic spying tool, conducting tens of thousands of warrantless “backdoor” searches for Americans’ private communications obtained under Section 702 every year.

Section 702 periodically sunsets; Congress most recently reauthorized …

Personal Jurisdiction’S Aberrant Theory Of Consent, Roger Michalski

American University Law Review

Consent has been a pillar of personal jurisdiction doctrine at least since Pennoyer. The Supreme Court recently strengthened this pillar by deeming a corporate registration statute to constitute consent. Consent to submit to a court’s adjudicatory power can now be unintentional, based on inaction, is irrevocable, does not have to be informed, is all-or-nothing, and is blind to power inequalities. Failing to say “no” at the right time in the right way means “yes.”

Such a theory of consent clashes with what consent means elsewhere. In other contexts, we are reminded that “no means no,” the “absence of no does …

The Software Inducement Paradox, Dylan Niederland

American University Law Review

Induced patent infringement allows a third party to be held liable for another’s direct infringement of a patent. For many years, inducement liability has been a hotly contested doctrine of patent law, specifically its applications in the pharmaceutical industry. Not unsurprisingly, vast literature exists covering the intersection of inducement liability and pharmaceuticals.

This Note takes a new approach, analyzing inducement liability as it relates to the software industry. Specifically, this Note criticizes the Federal Circuit’s holding in GlaxoSmithKline LLC v. Teva Pharmaceuticals USA, Inc. that a simple statement of equivalence is sufficient to induce users to infringe method-of-use patents that …

RaˉMaˉNuja's Cosmopsychist-Panentheistic Solution To The Hard Problem Of Consciousness, Anand Jayprakash Vaidya, S. Siddharth

Faculty Research, Scholarly, and Creative Activity

Recent decades have seen a renewal of interest in panpsychism as a solution to the hard problem of consciousness. This has, in part, also driven an increase in interest in classical Indian philosophical traditions among analytic philosophers of mind. Many of these cross-cultural studies pertaining to panpsychism (and cosmopsychism) have focused on one particularly influential school of Indian philosophy, Advaita (non-dual) Veda nta, the most famous proponent of which is sankara. In this work, we would like to consider the view of another influential philosopher and the school that developed based on his view - Rama nuja (eleventh century CE) …

Disaster Preparedness And Responsibility Perception In Disaster Situations In Rural Madagascar, Joel Raveloharimisy

Faculty Publications

No abstract provided.

Generating Synthetic Malware Samples Using Generative Ai, Tiffany Bao, Kylie Trousil, Quang Duy Tran, Fabio Di Troia, Younghee Park

Faculty Research, Scholarly, and Creative Activity

Malware attacks have a significant negative impact on organizations of varied scales in the field of cybersecurity. Recently, malware researchers have increasingly turned to machine learning techniques to combat sophisticated obfuscation methods used in malware. However, collecting a diverse set of malware samples with various obfuscation techniques is challenging and often takes years, especially for newly developed malware. This issue is further compounded by a well-known limitation of machine learning models: their poor performance when training data is scarce. In this paper, we propose a new system for generating synthetic malware samples to augment imbalanced malware dataset. Our approach decomposes …

What Makes An Airbnb Experience Memorable? A Text Analysis Using Leximancer, Eunjung Kim, Songshan Huang

Research outputs 2022 to 2026

This study explores the factors that contribute to memorable experiences in the context of Airbnb. An open-ended question, ‘Please describe your most memorable experience with Airbnb’, was asked in the survey, and a total of 824 valid responses were obtained. The qualitative analysis of the data was conducted using Leximancer. The findings highlight the significance of the ‘Stay’, ‘Home’, ‘Family’, ‘Host’, ‘Beach’, and ‘Use’ themes, each playing a vital role in creating memorable experiences. In particular, the present study extends these findings by offering a more nuanced understanding of these dimensions, with specific themes emerging in relation to different demographic …