Digital Commons Network^™

Complete Corpus Callosotomy Using A Frameless Navigation Probe Through A Minicraniotomy In Children With Medically Refractory Epilepsy: A Case Series And Technical Note, Ahmed Belal, Gretchen Von Allmen, Indira Kommuru, Jeremy Lankford, John C Mosher, Manish Shah, Michael Funke, Michael Watkins, Rajan Patel

Faculty, Staff and Student Publications

BACKGROUND: Medically refractory epilepsy constitutes up to one-third of the epilepsy pediatric patients. Corpus callosotomy (CC) has been used for the treatment of medically refractory epilepsy in children with atonic seizures and generalized tonic-clonic (GTC) seizures. In this case series study, we are describing a novel technique for CC using the frameless navigation probe through a minicraniotomy.

METHODS: Thirteen pediatric patients with the diagnosis of medically refractory epilepsy predominantly GTC with drop attack who underwent extensive Phase I. An L-shape was done, then through a 4 × 3 cm craniotomy, we were able to open the interhemispheric fissure until the …

Cerebral Infarctions In An Infant With Covid-19 Delta Variant Infection And Disseminated Tuberculosis, Stuart Fraser, Misti Ellsworth, Norma Perez, Hunter Hamilton, Stephen Fletcher, Deborah Brown, Lakshmi Srivaths

Faculty, Staff and Student Publications

No abstract provided.

Dysphagia Is Associated With Worse Clinical Outcomes In Geriatric Trauma Patients, Heather R Kregel, Mina Attia, Claudia Pedroza, David E Meyer, Michael W Wandling, Shah-Jahan M Dodwad, Charles E Wade, John A Harvin, Lillian S Kao, Thaddeus J Puzio

Faculty, Staff and Student Publications

INTRODUCTION: Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.

METHODS: Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, …

Renal Disease And The Heart, Hassan N Ibrahim

Faculty, Staff and Student Publications

No abstract provided.

Pain Management And Telemedicine: A Look At The Covid Experience And Beyond, Jamal Hasoon, Ivan Urits, Omar Viswanath, Alan D Kaye

Faculty, Staff and Student Publications

COVID-19 caused a drastic change in clinical medicine around the globe. In the United States, telemedicine was rapidly adopted on a wide scale to minimize direct patient interaction and to reduce the spread of the COVID-19 virus. Telemedicine also went hand in hand with the rapid movement of working remotely. This has provided several challenges to chronic pain management clinics along with other subspecialties. Telemedicine has also opened opportunities for providing valuable care for patients with significant barriers to healthcare professionals. Given the benefits and downfalls of telemedicine, it is ultimately up to the provider who has an established patient-physician …

Peripheral Nerve Stimulation For Chronic Shoulder Pain Due To Rotator Cuff Pathology, Ahish Chitneni, Jamal Hasoon, Ivan Urits, Omar Viswanath, Amnon Berger, Alan D Kaye

Faculty, Staff and Student Publications

Chronic shoulder pain affects millions of patients each year. Various conditions can result in shoulder pain ranging from rotator cuff injury, subacromial impingement, post-surgical pain, bursitis, adhesive capsulitis, and osteoarthritis. Typically, rotator cuff pathology is diagnosed by physical exam maneuvers along with advanced imaging modalities. Initial treatment for rotator cuff injury typically consists of physical therapy, NSAIDs, and possible injections depending on the extent of the injury. If conservative measures fail or the injury is too substantial, surgery is typically the appropriate treatment for healthy patients. For patients who are not surgical candidates or refuse surgery, peripheral nerve stimulation (PNS) …

A Survey On The Choice Of Spinal Cord Stimulation Parameters And Implantable Pulse Generators And On Reasons For Explantation, Jatinder S Gill, Lynn R Kohan, Jamal Hasoon, Ivan Urits, Omar Viswanath, Viet L Cai, Cyrus Yazdi, Musa M Aner, Alan D Kaye, Thomas T Simopoulos

Faculty, Staff and Student Publications

Objective: Spinal Cord Stimulation (SCS) is a vital treatment for chronic intractable pain. In the last few years, the field has undergone dramatic changes in new waveform and frequency introduction as well as device miniaturization. It is important to understand contemporary practice patterns regarding these parameters.

Methods: We surveyed the active membership of Spine Intervention Society (SIS), and American Society of Regional Anesthesia (ASRA) on their practices regarding various aspects of Spinal Cord Stimulation therapy. Here we report on SCS waveform usage, battery types, and causes of explant in this cohort of providers.

Results: There was similar degree of usage …

A Tapered Cuff Tracheal Tube Decreases The Need For Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial, Yi-Shiuan Li, Elise Chia-Hui Tan, Yueh-Ju Tsai, Mercedes Susan Mandell, Shiang-Suo Huang, Ting-Yun Chiang, Wen-Cheng Huang, Wen-Kuei Chang, Ya-Chun Chu

Faculty, Staff and Student Publications

Background: Surgical retraction to expose the vertebrae during anterior cervical spine surgery increases tracheal tube cuff pressure and may worsen postoperative sore throat and dysphonia. This randomized double-blind study investigated the effect of cuff shape on intraoperative cuff pressure and postoperative sore throat and dysphonia.

Methods: Eighty patients were randomized to tracheal intubation with a tapered cuff or a conventional cylindrical high-volume low-pressure cuff (control) during anesthesia. Intraoperative cuff pressures were compared. The primary outcome was the incidence of pressure adjustment needed when the cuff pressure increased to > 25 mm Hg after surgical retraction. The secondary outcome was the incidence …

The Pathology Fellowship Application Crisis: The Current State And Suggestions For Remediation, Amanda C Herrmann, Cheryl Hanau, Donald Karcher, Douglas C Miller, Alexandra Murtha, Ashley E Sanders, Charles Timmons, Karen L Kaul

Faculty, Staff and Student Publications

Problems within the Pathology fellowship application process in the US have been recognized and reported for years. Recently, members of the Graduate Medical Education Committee (GMEC) of the Association of Pathology Chairs (APC) and collaborators collected survey data from the residents themselves and the fellowship programs, as represented by both the fellowship program directors (members of the Fellowship Directors Ad Hoc Committee, FDAHC) and the program administrators (members of the Graduate Medical Education Administrators Section, GMEAS). These data are presented and discussed, and potential steps to resolve some of the problems around fellowship applications in pathology are presented.

Interictal Localization Of The Epileptogenic Zone: Utilizing The Observed Resonance Behavior In The Spectral Band Of Surrounding Inhibition, Omar A Alamoudi, Adeel Ilyas, Sandipan Pati, Leon Iasemidis

Faculty, Staff and Student Publications

Introduction

The gold standard for identification of the epileptogenic zone (EZ) continues to be the visual inspection of electrographic changes around seizures’ onset by experienced electroencephalography (EEG) readers. Development of an epileptogenic focus localization tool that can delineate the EZ from analysis of interictal (seizure-free) periods is still an open question of great significance for improved diagnosis (e.g., presurgical evaluation) and treatment of epilepsy (e.g., surgical outcome).

Methods

We developed an EZ interictal localization algorithm (EZILA) based on novel analysis of intracranial EEG (iEEG) using a univariate periodogram-type power measure, a straight-forward ranking approach, a robust dimensional reduction method and …

Catalytic Asymmetric Synthesis Of Carbocyclic C-Nucleosides, Sourabh Mishra, Florian C T Modicom, Conor L Dean, Stephen P Fletcher

Faculty, Staff and Student Publications

Access to carbocyclic C-nucleosides (CC-Ns) is currently restricted. The few methods available to make CC-Ns suffer from long syntheses and poor modularity, hindering the examination of potentially important chemical space. Here we report an approach to CC-Ns which uses an asymmetric Suzuki-Miyaura type reaction as the key C-C bond forming step. After coupling the densely functionalized racemic bicyclic allyl chloride and heterocyclic boronic acids, the trisubstituted cyclopentenyl core is elaborated to RNA analogues via a hydroborylation-homologation-oxidation sequence. We demonstrate that the approach can be used to produce a variety of enantiomerically enriched CC-Ns, including a carbocyclic derivative of Showdomycin.

Arthroscopic Stabilization Of Posterior Shoulder Instability Without Glenoid Bone Loss, Shawn D Feinstein, James M Gregory

Faculty, Staff and Student Publications

BACKGROUND: Contact athletes who experience posterior shoulder instability have a high likelihood of recurrence necessitating surgery.

INDICATIONS: Patients with posterior shoulder instability without glenoid or humeral head bone loss who have failed activity modification, bracing, and physical therapy may benefit from arthroscopic stabilization surgery.

TECHNIQUE DESCRIPTION: We describe a technique for arthroscopic labral repair with capsular plication through 4 portals in the lateral decubitus position.

RESULTS: Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for posterior shoulder instability with good patient-reported outcomes, low recurrence rates, and high rate of return-to-play.

DISCUSSION/CONCLUSION: Arthroscopic capsulolabral reconstruction in the lateral decubitus position …

Digital Rehabilitation For Hand And Wrist Pain: A Single-Arm Prospective Longitudinal Cohort Study, Fabíola Costa, Dora Janela, Maria Molinos, Robert G Moulder, Jorge Lains, Gerard E Francisco, Virgílio Bento, Vijay Yanamadala, Steven P Cohen, Fernando Dias Correia

Faculty, Staff and Student Publications

Introduction: Wrist and hand represent the third most common body part in work-related injuries, being associated with long-term absenteeism. Telerehabilitation can promote access to treatment, patient adherence, and engagement, while reducing health care-related costs.

Objective: Report the results of a fully remote digital care program (DCP) for wrist and hand pain (WP).

Methods: A single-arm interventional study was conducted on individuals with WP applying for a DCP. Primary outcome was the mean change in the Numerical Pain Rating Scale after 8 weeks (considering a minimum clinically important change of 30%). Secondary outcomes were: disability (Quick Disabilities of the Arm, Shoulder, …

Emerging Evidence For Intrathecal Management Of Neuropathic Pain Following Spinal Cord Injury, Jay Karri, James Doan, Christian Vangeison, Marissa Catalanotto, Ameet S Nagpal, Sheng Li

Faculty, Staff and Student Publications

A high prevalence of patients with spinal cord injury (SCI) suffer from chronic neuropathic pain. Unfortunately, the precise pathophysiological mechanisms underlying this phenomenon have yet to be clearly elucidated and targeted treatments are largely lacking. As an unfortunate consequence, neuropathic pain in the population with SCI is refractory to standard of care treatments and represents a significant contributor to morbidity and suffering. In recent years, advances from SCI-specific animal studies and translational models have furthered our understanding of the neuronal excitability, glial dysregulation, and chronic inflammation processes that facilitate neuropathic pain. These developments have served advantageously to facilitate exploration into …

A Case Of Neuroparacoccidioidomycosis In Houston, Texas, Maitreyi Narayan, Swetha Jayavelu, Harsh Goel, Joshua R Rosenthal, Gabriel M Aisenberg

Faculty, Staff and Student Publications

Paracoccidioidomycosis is a systemic fungal disease caused by the dimorphic Paracoccidioides species endemic to South America. Infection classically presents with pulmonary, mucosal, or reticuloendothelial involvement, though other organs can be involved. Central nervous system involvement is rare, and almost universally reported within the endemic area for the fungus. We present a 60-year-old Brazilian male who complained of occipital headache, ataxia, dysmetria, and dysarthria for two months, diagnosed with neuroparacoccidioidomycosis in Houston, Texas. The patient had a cerebellar mass and a left pulmonary spiculated apical mass suspicious for a lung metastatic malignancy and a preliminary histological report consistent with invasive cryptococcosis. …

Targeting Etosis By Mir-155 Inhibition Mitigates Mixed Granulocytic Asthmatic Lung Inflammation, Ji Young Kim, Patrick Stevens, Manjula Karpurapu, Hyunwook Lee, Joshua A Englert, Pearlly Yan, Tae Jin Lee, Navjot Pabla, Maciej Pietrzak, Gye Young Park, John W Christman, Sangwoon Chung

Faculty, Staff and Student Publications

Asthma is phenotypically heterogeneous with several distinctive pathological mechanistic pathways. Previous studies indicate that neutrophilic asthma has a poor response to standard asthma treatments comprising inhaled corticosteroids. Therefore, it is important to identify critical factors that contribute to increased numbers of neutrophils in asthma patients whose symptoms are poorly controlled by conventional therapy. Leukocytes release chromatin fibers, referred to as extracellular traps (ETs) consisting of double-stranded (ds) DNA, histones, and granule contents. Excessive components of ETs contribute to the pathophysiology of asthma; however, it is unclear how ETs drive asthma phenotypes and whether they could be a potential therapeutic target. …

Dysregulated Hypothalamic-Pituitary-Adrenal Axis Is Associated With Increased Inflammation And Worse Outcomes After Ischemic Stroke In Diabetic Mice, Sehee Kim, Eun S Park, Peng R Chen, Eunhee Kim

Faculty, Staff and Student Publications

Diabetic patients have larger infarcts, worse neurological deficits, and higher mortality rate after an ischemic stroke. Evidence shows that in diabetes, the hypothalamic-pituitary-adrenal (HPA) axis was dysregulated and levels of cortisol increased. Based on the role of the HPA axis in immunity, we hypothesized that diabetes-dysregulated stress response exacerbates stroke outcomes via regulation of inflammation. To test this hypothesis, we assessed the regulation of the HPA axis in diabetic mice before and after stroke and determined its relevance in the regulation of post-stroke injury and inflammation. Diabetes was induced in C57BL/6 mice by feeding a high-fat diet and intraperitoneal injection …

Career Transitions: Reflections Of Former Chairs And Academic Health Center Leaders, David N Bailey, L Maximilian Buja, Avrum I Gotlieb, Deborah E Powell, Fred Sanfilippo

Faculty, Staff and Student Publications

The 2022 Association of Pathology Chairs Annual Meeting included a live discussion session and a pre-meeting recorded panel webinar sponsored by the Senior Fellows Group (former chairs of academic departments of pathology who have remained active in the Association of Pathology Chairs). The presentation was focused on transition planning for academic health center leaders. Each of the discussion group panelists had served as a pathology department chair as well as in more senior leadership positions, and they provided perspectives based upon their personal experiences. It was noted that such positions are often "at will" appointments of indeterminate length and that …

Clinicopathological Correlations In Heart Transplantation Recipients Complicated By Death Or Re-Transplantation, Michelle M Mcdonald, Maks Mihalj, Bihong Zhao, Sriram Nathan, Stanislava Matejin, Giulia Ottaviani, Mateja K Jezovnik, Rajko Radovancevic, Biswajit Kar, Igor D Gregoric, L Maximilian Buja

Faculty, Staff and Student Publications

PURPOSE: This study aimed to identify and correlate pathological findings with clinical outcomes in patients after orthotopic heart transplantation (OHT) who either died or underwent a re-transplantation.

METHODOLOGY AND STUDY DESIGN: Single-center retrospective analysis of primary OHT patients who died or were re-transplanted between October 2012 and July 2021. Clinical data were matched with corresponding pathological findings from endomyocardial biopsies on antibody-mediated rejection, cellular rejection, and cardiac allograft vasculopathy. Re-assessment of available tissue samples was performed to investigate acute myocardial injury (AMI) as a distinct phenomenon. These were correlated with clinical outcomes, which included severe primary graft dysfunction. Patients were …

Why Does The Federal Government Get A Pass? Applying Best Practices In Child Protection To The Circumstances Of Migrant Children And Families, Randi Mandelbaum

American University Law Review

For too long, the United States has had a separate child-caring system for migrant children and families that operates alongside our domestic child welfare systems. The latter is a robust system focused on the principles of safety, wellbeing, and permanency; while the former flouts constitutional protections, separates children from parents, and perpetuates a system that is detaining children, warehousing them in large jail-like settings at worst, and sheltering them in large congregate care facilities at best. Children are being harmed, some irreparably.

Yet, if our child welfare laws reflect what we know to be proper standards for caring for vulnerable …

Misinformation About Marijuana: Commercialization, Consolidation, And The New First Amendment, David Angelatos

American University Law Review

From “Reefer Madness” to “This Is Your Brain on Drugs,” Americans have lived through decades of anti-cannabis propaganda. Legalization is poised to turn this information environment on its head, unleashing a torrent of corporate-funded, pro-cannabis misinformation that regulators cannot prevent or dispel. This appears to be a problem caused by the Supreme Court’s creation and expansion over the past fifty years of First Amendment protections for corporate and commercial speech. Although these doctrines contribute substantially to the problem, this Article shows how it originates in lax antitrust policy rather than expansive First Amendment jurisprudence.

If Congress follows current legalization trends …

Urinary T Cells Are Detected In Patients With Immune Checkpoint Inhibitor-Associated Immune Nephritis That Are Clonotypically Identical To Kidney T Cell Infiltrates, Shailbala Singh, Leticia C Clemente, Edwin R Parra, Amanda Tchakarov, Chao Yang, Yisheng Li, James P Long, Cassian Yee, Jamie S Lin

Faculty, Staff and Student Publications

Acute kidney injury (AKI) occurs in ~20% of patients receiving immune checkpoint inhibitor (ICI) therapy; however, only 2-5% will develop ICI-mediated immune nephritis. Conventional tests are nonspecific in diagnosing disease pathology and invasive procedures (i.e. kidney biopsy) may not be feasible. In other autoimmune renal diseases, urinary immune cells correlated with the pathology or were predictive of disease activity. Corresponding evidence and analysis are absent for ICI-mediated immune nephritis. We report the first investigation analyzing immune cell profiles of matched kidney biopsies and urine of patients with ICI-AKI. We demonstrated the presence of urinary T cells in patients with immune …

Enhancing Mesenchymal Stromal Cell Potency: Inflammatory Licensing Via Mechanotransduction, Max A Skibber, Scott D Olson, Karthik S Prabhakara, Brijesh S Gill, Charles S Cox

Faculty, Staff and Student Publications

Mesenchymal stromal cells (MSC) undergo functional maturation upon their migration from bone marrow and introduction to a site of injury. This inflammatory licensing leads to heightened immune regulation via cell-to-cell interaction and the secretion of immunomodulatory molecules, such as anti-inflammatory mediators and antioxidants. Pro-inflammatory cytokines are a recognized catalyst of inflammatory licensing; however, biomechanical forces, such as fluid shear stress, are a second, distinct class of stimuli that incite functional maturation. Here we show mechanotransduction, achieved by exposing MSC to various grades of wall shear stress (WSS) within a scalable conditioning platform, enhances the immunomodulatory potential of MSC independent of …

Incidence Of Readmission Following Pediatric Hand Surgery: An Analysis Of 6600 Patients, Christopher J Goodenough, Cassie A Hartline, Shuyan Wei, Joseph K Moffitt, Alfredo Cepeda, Phuong D Nguyen, Matthew R Greives

Faculty, Staff and Student Publications

BACKGROUND: Quality in surgical outcomes is frequently assessed by the 30-day readmission rate. There are limited data available in the published literature regarding readmission rates following pediatric hand surgery. This study aims to identify factors associated with an increased risk of readmission following hand surgery in a pediatric population.

METHODS: The 2012-2017 National Surgical Quality Improvement Project - Pediatric (NSQIP-P) databases were queried for pediatric patients who underwent procedures with hand-specific current procedural terminology (CPT) codes. The primary outcome was readmission.

RESULTS: A total of 6600 pediatric patients were identified and included in the analysis. There were 45 patients who …

Dysphagia Is Associated With Worse Clinical Outcomes In Geriatric Trauma Patients, Heather R Kregel, Mina Attia, Claudia Pedroza, David E Meyer, Michael W Wandling, Shah-Jahan M Dodwad, Charles E Wade, John A Harvin, Lillian S Kao, Thaddeus J Puzio

Faculty, Staff and Student Publications

INTRODUCTION: Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.

METHODS: Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, …

Autologous Cellular Therapy For Cerebral Palsy: A Randomized, Crossover Trial, Charles S Cox, Jenifer Juranek, Steven Kosmach, Claudia Pedroza, Nivedita Thakur, Allison Dempsey, Kimberly Rennie, Michael C Scott, Margaret Jackson, Akshita Kumar, Benjamin Aertker, Henry Caplan, Fabio Triolo, Sean I Savitz

Faculty, Staff and Student Publications

We examined an autologous mononuclear-cell-therapy-based approach to treat cerebral palsy using autologous umbilical cord blood or bone-marrow-derived mononuclear cells. The primary objective was to determine if autologous cells are safe to administer in children with cerebral palsy. The secondary objectives were to determine if there was improvement in motor function of patients 12 months after infusion using the Gross Motor Function Measure and to evaluate impact of treatment on corticospinal tract microstructure as determined by radial diffusivity measurement. This Phase 1/2a trial was a randomized, blinded, placebo-controlled, crossover study in children aged 2–10 years of age with cerebral palsy enrolled …

Structure Of The Hsp110:Hsc70 Nucleotide Exchange Machine, Yusra Ahmed, Jeremy Miciak, W Pat Taylor, David J Francis

Faculty, Staff and Student Publications

We evaluate the direct and inferential mediation (DIME) model for reading comprehension with a sample of struggling readers in Grades 3 to 5 (N = 364) in the context of a large-scale randomized controlled trial (RCT) investigating two theoretically distinct reading interventions (text processing + foundational skills [n = 117] or text processing only [n = 120]) and a control condition (n = 127). We investigate whether the intervention affects not just reading comprehension levels, but also how variables within the reading system interrelate. This approach allows the focus to shift from intervention as influencing a …

The Novel Use Of Biplane Imaging For Ultrasound-Guided Regional Anesthesia, Yusra Ahmed, Shawn Kent, Paul T Cirino, Milena Keller-Margulis

Faculty, Staff and Student Publications

Research suggests that executive function, motivation, transcription, and composition processes are implicated in the writing quality and productivity of children with and without learning difficulties. However, numerous components embedded within these constructs create both conceptual and empirical challenges to the study of written expression. These challenges are reflected in the writing research by way of poor delineation of constructs and insufficient distinction among domain general resources (e.g. working memory) versus processes related to the academic domain of writing (e.g. pre-planning), as well as among lower- (e.g. handwriting) and higher-order (e.g. editing) writing-specific processes. The current study utilizes the Not-so-Simple View …

Informal Science, Technology, Engineering And Math Learning Conditions To Increase Parent Involvement With Young Children Experiencing Poverty, Tricia A Zucker, Gloria Yeomans Maldonado, Michael Assel, Cheryl Mccallum, Cindy Elias, John M Swint, Lincy Lal

Faculty, Staff and Student Publications

Broadening participation in early science, technology, engineering and math (STEM) learning outside of school is important for families experiencing poverty. We evaluated variations of the Teaching Together STEM pre-kindergarten program for increasing parent involvement in STEM learning. This informal STEM, family engagement program was offered in 20 schools where 92% of students received free/reduced lunch. The core treatment included a series of family education workshops, text messages, and family museum passes. The workshops were delivered at school sites by museum outreach educators. We randomly assigned schools to business-as-usual control or one of three additive treatment groups. Using an additive treatment …

The Value Of Peer Support In Curbing Moral Injury: A Resident’S Perspective, May W Chen, Jennifer K Lee, Gilbert Vezina, Aylin Tekes, Jamie Perin, Ruoying Li, Alexandra O'Kane, Meaghan Mcgowan, Taeun Chang, Charlamaine Parkinson, Colleen Krein, Tareq Al-Shargabi, Frances J Northington, Ken M Brady, An N Massaro, Rathinaswamy B Govindan

Faculty, Staff and Student Publications

Identifying the hemodynamic range that best supports cerebral perfusion using near infrared spectroscopy (NIRS) autoregulation monitoring is a potential physiologic marker for neonatal hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia. However, an optimal autoregulation monitoring algorithm has not been identified for neonatal clinical medicine. We tested whether the hemoglobin volume phase (HVP), hemoglobin volume (HVx), and pressure passivity index (PPI) identify changes in autoregulation that are associated with brain injury on MRI or death. The HVP measures the phase difference between a NIRS metric of cerebral blood volume, the total hemoglobin (THb), and mean arterial blood pressure (MAP) at the frequency …