Digital Commons Network^™

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 …

The Reliability Gap: How Traditional Search Engines Outperform Artificial Intelligence (Ai) Chatbots In Rosacea Public Health Information Quality, Houston C. Nelson, Morgan T. Beauchamp, April A. Pace

Department of Medicine Faculty Publications

Background: The internet has become a primary source of health information for the public, with important implications for patient decision-making and public health outcomes. However, the quality and readability of this content vary widely. With the rise of generative artificial intelligence (AI) tools such as ChatGPT and Gemini, new challenges and opportunities have emerged in how patients access and interpret medical information.

Objective: To evaluate and compare the quality, credibility, and readability of consumer health information provided by traditional search engines (Google, Bing) and generative AI platforms (ChatGPT, Gemini) using three validated instruments: DISCERN, JAMA Benchmark Criteria, and Flesch-Kincaid Readability …

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, …

Her2 Alterations Across Solid Tumors: Implications For Comprehensive Testing, Ahmed Ismail, Chimay Jani, Nusrat Jahan, Malla Midhun, Arnab Basu, Garima Gupta, Bassel El-Rayes, Sejong Bae, Tyler Mattox, Cyntanna Hawkins, Rebecca C. Arend, Mehmet Akce, Yanis Boumber, Aakash Desai

Department of Medicine Faculty Publications

Purpose

ERBB2 (HER2) alterations (e.g., overexpression, amplification, and mutations) are known to drive tumor progression. These changes, particularly in non-breast and gastric/gastroesophageal cancers, remain poorly characterized. With pan-tumor approval of HER2-targeted therapies like Trastuzumab deruxetecan (T-DXd), understanding ERBB2 alterations across diverse cancers is crucial.

Methods

HER2 analysis was conducted on 653 solid tumor specimens at the University of Alabama, using immunohistochemistry (IHC), copy number (CN) variation (CNV) assessment, and mutational profiling. The correlation between CN amplification and IHC expression was evaluated using Somers' D ordinal association.

Results

Of the 653 cases, HER2 IHC scores were distributed as 3 + (3.1%), …

Percutaneous Levoatrial Cardinal Vein Closure For Stroke Prevention, Chee Spencer, Amir Hasani, Alexander Ellis, David Adler

Department of Medicine Faculty Publications

We report 2 cases of cerebral embolism related to congenital levoatrial cardinal vein anomalies. Both patients had positive echocardiographic agitated saline studies but intact interatrial septum on transesophageal echocardiography. Levoatrial cardinal vein was diagnosed using computed tomography angiography. A novel technique for percutaneous levoatrial cardinal vein closure using vascular plug devices was successful in both patients.

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 …

Blood Culture Utilization: How Many Follow-Up Cultures Are Needed?, George Jones, Jennifer Hanrahan

Department of Medicine Faculty Publications

Background: Follow-up blood cultures (BCx) are ordered after an initial positive culture in many instances. The number of follow-up cultures needed is not clear. Obtaining unnecessary BCx may cause unintended consequences. The optimal balance between stewardship and patient safety warrants investigation. We sought to assess the frequency with which a third set is positive after a negative second BCx. Methods: We conducted a retrospective study of BCx submitted to the microbiology laboratory from 1/1/18-11/1/23. We included all patients ≥18 years who had at least two follow-up BCx drawn 24-72 hours after an initial positive culture. Data were collected from electronic …

Screening And Addressing Food Insecurity At Free Clinics: A Scoping Review, Gautam Ramanathan, William Zak, Daiwik Munjwani, Robert Fisher, Esther May Sarino, Mary J. Scourboutakos

Department of Medicine Faculty Publications

Food insecurity (FI) is highly prevalent amongst patients seeking care at free, student-run health clinics. This study sought to examine the existing literature of food insecurity screenings and interventions at free clinics across the U.S. In this review, we provide the rate of FI screenings, the prevalence of FI, demographic information of patients screened, and interventions and barriers faced by clinics while implementing interventions to improve FI. Studies included in this review needed to implement a FI screening and intervention program in a free clinic within the United States. Additionally, eligible studies could address additional social determinants of health or …

Role Of Device Therapy In Complementing Contemporary Medical Management, Yoel Benarroch, Natalie Tapaskar, Amin Yehya

Department of Medicine Faculty Publications

Heart failure (HF) is a clinical syndrome characterized by signs and symptoms resulting from any structural or functional deficiency of ventricular filling or blood ejection. The mainstay of initial treatment remains lifestyle modifications, guideline-directed medical therapy, and addressing contributing factors. However, the past two decades have come with significant advances in device therapies to improve morbidity and mortality in HF despite evidence-based management as above. Given the rapidly evolving area of HF research and therapeutic development, it is important for clinicians to be familiar with novel therapies and how they can complement medical management. In this review we discuss the …

Percutaneous Closure Of A Left Ventricular Pseudoaneurysm Using A Post-Infarct Vsd Device Guided By Intracardiac Echocardiography, Omar Jafar, Nicholas Valle, Rupinder Bahniwal, Matthew Summers

Department of Medicine Faculty Publications

Left ventricular pseudoaneurysm (LVPA) is a rare, life-threatening complication that may arise after cardiac surgery, myocardial infarctions, or infective endocarditis. We present a case of a 55-year-old woman with complex surgical history and prior infective endocarditis who developed an incidental LVPA. Due to lack of surgical repair options, a percutaneous approach was pursued using a post-infarct ventricular septal defect device (PIVSD) under guidance of fluoroscopy and intracardiac echocardiography (ICE) guidance with successful exclusion of LVPA. This case highlights the utility of multimodal imaging in the percutaneous management of complex left ventricular lesions.

Cardiomyopathies Of Endocrine Origin: A State-Of-The-Art Review, Jenyfer M. Fuentes-Mendoza, Marcio J. Concepción-Zavaleta, Juan C. Morón-Siguas, Juan M. Muñoz-Moreno, Aranza I. Pérez-Reyes, Rodrigo Martinez-Galaviz, Raúl D. Aguilar-Castañeda, Oziel González-Godoy, Luis A. Concepción-Urteaga, José Paz-Ibarra

Department of Medicine Faculty Publications

Endocrine disorders are increasingly recognized as potentially reversible causes of secondary cardiomyopathies, yet they often remain underdiagnosed in clinical practice. These conditions-including thyroid dysfunction, acromegaly, pheochromocytoma, diabetes mellitus, adrenal disorders, among others-can significantly alter cardiac structure and function through hormonal excess, metabolic remodeling, and neurohumoral activation. Hyperthyroidism may lead to high-output heart failure (HF) and atrial fibrillation, while hypothyroidism is associated with diastolic dysfunction, pericardial effusion, and accelerated atherosclerosis. Acromegaly promotes biventricular hypertrophy and myocardial fibrosis via insulin-like growth factor 1 overproduction. Pheochromocytoma triggers catecholamine-induced cardiomyopathy, resembling Takotsubo syndrome and carrying a high risk of mortality if left untreated. Diabetes …

Fibrinolysis For Apical Thrombus As A Bridge To Emergent Valve-In-Valve Transcatheter Aortic Valve Replacement, Nicholas J. Valle, Omar A. Saleh, Mani C. Akunuri, Parth K. Parikh, Joshua A. Cohen, Deepak R. Talreja, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Left ventricular (LV) thrombus is traditionally a contraindication to transcatheter aortic valve replacement due to embolic risk. Consequently, management of valvular cardiogenic shock complicated by LV thrombus identifies unique challenges that require innovative strategies.

Case Summary

A 58-year-old woman with critical bioprosthetic aortic stenosis, cardiogenic shock, and large LV thrombus (2.8 × 2.6 cm) underwent successful valve-in-valve transcatheter aortic valve replacement after systemic fibrinolysis bridge therapy.

Why Beyond the Guidelines

Current guidelines contraindicate transcatheter aortic valve replacement in patients with LV thrombus. This case demonstrates the novel use of low-dose, slow infusion tissue plasminogen activator as a bridge therapy …

Oral Anticoagulation Versus No Anticoagulation After Spontaneous Intracranial Hemorrhage In Patients With Atrial Fibrillation: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials, Prathik Saravanan, Vaibhav Vats, Abouchita Rimane, Shrishti Agarwal, Srinidhi Kondepudi, Mathew Reji, Batoul Taqi, Naser Ashraf Tadvi, Preeti Elizabeth Jossy, Anjana Kumaram Kunnel Sabu, Asma's Munasar Ali Alsubari, Ranjit Sah, Hira Sarfraz, Muhammad Usman Khan, Abdullah Wahab Arif

Department of Medicine Faculty Publications

The decision to resume oral anticoagulation (OAC) in patients with atrial fibrillation (AF) after an intracranial hemorrhage (ICH) remains a significant clinical challenge due to competing risks of ischemic stroke and recurrent bleeding. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing long-term OAC with no OAC in patients with AF following an ICH. We searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov through September 2025. The primary outcomes were ischemic stroke and ICH. Secondary outcomes included major adverse cardiovascular events (MACE), major bleeding, cardiovascular mortality, and all-cause mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were …

Blunt Trauma Causing Thrombotic Occlusive Myocardial Infarction, Jace Bradshaw, Alleabelle Bradshaw, Rishab Agarwal, P. Logan Weygandt

Department of Medicine Faculty Publications

Introduction: Traumatic myocardial infarction (TMI) is a rare but serious complication of blunt chest trauma, typically arising from coronary artery dissection, intramural hematoma, or myocardial contusion. Early recognition and intervention are critical, but diagnosis can be challenging given the broad differential for chest pain in trauma patients.

Case presentation: A 66-year-old female presented to a quaternary academic emergency department after a motor vehicle collision with progressive chest pain. Initial electrocardiogram (ECG) showed hyperacute T-waves in lead III, ST depression with T-wave inversion in aVL, and ST depression in V2, with posterior leads revealing ST elevation in V7–V9. Trauma imaging ruled …

Annual Report Of The Town Dalton, Nh, December 31, 2024, Dalton Town Representatives

Dalton, NH Annual Reports

This is an annual report containing vital statistics for a town/city in the state of New Hampshire.

Outcomes In Pediatric Cholesteatoma, Michael S Cohen, David H Chi, Samantha Anne

Faculty, Staff and Students Publications

OBJECTIVE: The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database.

STUDY DESIGN: Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022.

METHODS: Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up tympanomastoidectomy (TM-CWU), and tympanoplasty with canal wall-down tympanomastoidectomy (TM-CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids.

RESULTS: A total of 6304 patients were identified in the database who …

Deep Reinforcement Learning With Explicit Context Representation, Francisco Munguia-Galeano, Ah-Hwee Tan, Ze Ji

Research Collection School Of Computing and Information Systems

Though reinforcement learning (RL) has shown an outstanding capability for solving complex computational problems, most RL algorithms lack an explicit method that would allow learning from contextual information. On the other hand, humans often use context to identify patterns and relations among elements in the environment, along with how to avoid making wrong actions. However, what may seem like an obviously wrong decision from a human perspective could take hundreds of steps for an RL agent to learn to avoid. This article proposes a framework for discrete environments called Iota explicit context representation (IECR). The framework involves representing each state …

Last Digit Tendency: Lucky Number And Psychological Rounding In Mobile Transactions, Hai Wang, Tian Lu, Yingjie Zhang, Yue Wu, Yiheng Sun, Jingran Dong, Wen Huang

Research Collection School Of Computing and Information Systems

The distribution of digits in numbers obtained from different sources reveals interesting patterns. The well-known Benford’s law states that the first digits in many real-life numerical data sets have an asymmetric, logarithmic distribution in which small digits are more common; this asymmetry diminishes for subsequent digits, and the last digit tends to be uniformly distributed. In this paper, we investigate the digit distribution of numbers in a large mobile transaction data set with 835 million mobile transactions and payments made by approximately 460,000 users in more than 300 cities. Although the first digits of the numbers in these mobile transactions …

Flowing Together Or Alone: Impact Of Collaboration In The Metaverse, Fiona Fui-Hoon Nah, Brenda Eschenbrenner, Langtao Chen

Research Collection School Of Computing and Information Systems

The metaverse is the next-generation Internet (Web3) that facilitates social connections and collaborations in a virtual world environment. Given the potential of the metaverse to provide more satisfying and effective means of remote collaborations, exploring the possibility of leveraging the metaverse for these endeavors is warranted. Therefore, an important question to address is whether greater engagement occurs when tasks are completed collaboratively versus individually in the metaverse. We address this question by drawing on flow and transportation theories to hypothesize the effect of carrying out a creative task in the metaverse collaboratively versus alone on one's cognitive absorption, a contextually …

Marrying Top-K With Skyline Queries: Operators With Relaxed Preference Input And Controllable Output Size, Kyriakos Mouratidis, Keming Li, Bo Tang

Research Collection School Of Computing and Information Systems

The two most common paradigms to identify records of preference in a multi-objective setting rely either on dominance (e.g., the skyline operator) or on a utility function defined over the records' attributes (typically, using a top-k query). Despite their proliferation, each of them has its own palpable drawbacks. Motivated by these drawbacks, we identify three hard requirements for practical decision support, namely, personalization, controllable output size, and flexibility in preference specification. With these requirements as a guide, we combine elements from both paradigms and propose two new operators, ORD and ORU. We perform a qualitative study to demonstrate how they …

Bi-Objective Dynamic Tugboat Scheduling With Speed Optimization Under Stochastic And Time-Varying Service Demands, Xiaoyang Wei, Hoong Chuin Lau, Zhe Xiao, Xiuju Fu, Xiaocai Zhang, Zheng Qin

Research Collection School Of Computing and Information Systems

With the growing emphasis on green shipping to reduce the environmental impact of maritime transportation, optimizing fuel consumption with maintaining high service quality has become critical in port operations. Ports are essential nodes in global supply chains, where tugboats play a pivotal role in the safe and efficient maneuvering of ships within constrained environments. However, existing literature lacks approaches that address tugboat scheduling under realistic operational conditions. To fill the research gap, this is the first work to propose the bi-objective dynamic tugboat scheduling problem that optimizes speed under stochastic and time-varying demands, aiming to minimize fuel consumption and manage …

Non-Targeted Analysis And Suspect Screening Of Organic Contaminants In Temperature Snowfall Using Liquid Chromatography High-Resolution Mass Spectrometry, Stephanie Nino-Suastegui, Eve Painter, Jameson Sprankle, Jillian Morrison, Jennifer Faust, Rebekah Gray

All Faculty Articles

Contaminants released into the atmosphere that undergo regional and long-range transport can deposit back to Earth through snowfall. When snow melts, these contaminants re-enter the environment, sometimes far from their original emission sources. Here we present the first comprehensive characterization of organic contaminants in snow from North America. Fresh snowfall samples were collected in the central United States over a three-year period and measured by liquid chromatography high-resolution mass spectrometry for suspect screening and non-targeted analysis. The resulting data set was screened against experimental MS/MS libraries and underwent supplemental in silico MS/MS analysis. In total, 91 possible compounds were tentatively …

A Theoretical Study On The Environmental Oxidation Of Fenpyrazamine Fungicide Initiated By Hydroxyl Radicals In The Aqueous Phase, Hisham K. Al Rawas, Dinh Hieu Truong, Emma Schell, Jennifer Faust, Sonia Taamalli, Marc Ribaucour, Abderrahman El Bakali, Nissrin Alharzali, Duy Quang Dao, Florent Louis

All Faculty Articles

Fenpyrazamine (FPA) is a widely used fungicide in agriculture to control fungal diseases, but its environmental degradation by oxidants and the formation of potential degradation products remain unexplored. This study investigates the oxidation of FPA by hydroxyl radicals (HO˙) using density functional theory (DFT) calculations at the M06-2X/6-311++G(3df,3pd)//M06-2X/6-31+G(d,p) level of theory. Three standard oxidation mechanisms, including formal hydrogen transfer (FHT), radical adduct formation (RAF), and single electron transfer (SET), were evaluated in the aqueous phase, with reaction kinetics analyzed over a temperature range of 283–333 K. As a result, the reactivity order of the mechanisms was determined to be RAF …

Fuzzing Drones For Anomaly Detection: A Systematic Literature Review, Vikas Kumar Malviya, Wei Minn, Lwin Khin Shar, Lingxiao Jiang

Research Collection School Of Computing and Information Systems

Drones, also referred to as Unmanned Aerial Vehicles (UAVs), are becoming popular today due to their uses in different fields and recent technological advancements which provide easy control of UAVs via mobile apps. However, UAVs may contain vulnerabilities or software bugs that cause serious safety and security concerns. For example, the communication protocol used by the UAV may contain authentication and authorization vulnerabilities, which may be exploited by attackers to gain remote access over the UAV. Drones must therefore undergo extensive testing before being released or deployed to identify and fix any software bugs or security vulnerabilities. Fuzzing is one …

Measuring Model Alignment For Code Clone Detection Using Causal Interpretation, Shamsa Abid, Xuemeng Cai, Lingxiao Jiang

Research Collection School Of Computing and Information Systems

Deep Neural Network-based models have demonstrated high accuracy for semantic code clone detection. However, the lack of generalization poses a threat to the trustworthiness and reliability of these models. Furthermore, the black-box nature of these models makes interpreting the model’s decisions very challenging. Currently, there is only a limited understanding of the semantic code clone detection behavior of existing models. There is a lack of transparency in understanding how a model identifies semantic code clones and the exact code components influencing its prediction. In this paper, we introduce the use of a causal interpretation framework based on the Neyman-Rubin causal …

A Review Of Chinese Sentiment Analysis: Subjects, Methods, And Trends, Zhaoxia Wang, Donghao Huang, Jingfeng Cui, Xinyue Zhang, Seng-Beng Ho, Erik Cambria

Research Collection School Of Computing and Information Systems

Sentiment analysis has emerged as a prominent research domain within the realm of natural language processing, garnering increasing attention and a growing body of literature. While numerous literature reviews have examined sentiment analysis techniques, methods, topics and applications, there remains a gap in the literature concerning thematic trends and research methodologies in sentiment analysis, particularly in the context of Chinese text. This study addresses this gap by presenting a comprehensive survey dedicated to the progression of research subjects, methods and trends in sentiment analysis of Chinese text. Employing a framework that combines keyword co-occurrence analysis with a sophisticated community detection …

Performance Evaluation Of Newsql Databases In A Distributed Architecture, Zhiyao Zhang, Alan @ Ali Madjelisi Megargel, Lingxiao Jiang

Research Collection School Of Computing and Information Systems

In the last decade, application architectures have evolved drastically, moving from monolithic architectures to distributed architectures where deployment has shifted from dedicated on-premises servers to the cloud. Distributed architectures and cloud computing has enabled businesses to scale their application components across different geographical locations. While it is easy to scale the application layer, scaling its database layer that relies on traditional SQL databases is challenging and often is a common source of bottlenecks when it comes to application performance. This paper evaluates the performance characteristics between two NewSQL databases solutions, MySQL NDB Cluster vs. TIBCO ActiveSpaces IMDG. Serving as an …