Medicine and Health Sciences Commons^™

Diagnostic Criteria And Management Of Melas And Stroke-Like Episodes: Consensus-Based Statements, Michelangelo Mancuso, Marcello Bellusci, Valerio Carelli, Irenaeus De Coo, Daria Diodato, Felix Distelmaier, Omar Hikmat, Michio Hirano, Rita Horvath, Amel Karaa, Thomas Klopstock, Mary Kay Koenig, Cornelia Kornblum, Chiara La Morgia, Piervito Lopriore, Mika Henrik Martikainen, Robert Mcfarland, Olimpia Musumeci, Robert D S Pitceathly, Guido Primiano, Shamima Rahman, Fernando Scaglia, Andrew Schaefer, Manuel Schiff, Luisa Semmler, Costanza Lamperti, Serenella Servidei

Faculty, Staff and Student Publications

Background and purpose: Mitochondrial Encephalomyopathy, Lactic acidosis and Stroke-like episodes (MELAS) is a rare multisystem mitochondrial disorder with clinical heterogeneity. Diagnostic criteria and management strategies for MELAS and mitochondrial stroke-like episodes (SLE) remain inconsistent. This work provides international consensus recommendations on the definition, diagnosis, and management of MELAS and SLE in pediatric and adult populations.

Methods: An international Delphi consensus process was conducted within the European Reference Network for Neuromuscular Diseases (ERN EURO-NMD), in collaboration with the US Mitochondrial Medicine Society, the ERN for Hereditary Metabolic Disorders (MetabERN), and patient representatives. Following a systematic literature review, 54 statements addressing diagnostic …

Impact Of Cannabis And Cannabis Legalization On Us Atrial Septal Defect Rates, Albert Stuart Reece, Hulse

Research outputs 2022 to 2026

Atrial septal defect (ASD) affects 1:11.3 children in some US states; however, the antecedents of these trends are yet to be identified. A total of 1882 ASD rates (ASDRs) for 2003–2020 were sourced from the National Birth Defects Prevention Network reports. A total of 406,893 ASDs are reported. Substance (cigarettes, binge alcohol, cannabis, cannabinoids, analgesics, cocaine) exposure data were taken from the National Survey of Drug Use and Health. Income and ethnicity data were derived from the US Census. Adjustment was performed by mixed effects, survey and generalized additive regression. Causal analysis was by inverse probability weighting and E-values. Data …

Longitudinal Assessment Of Health-Related Quality Of Life In Adults With Ckd, Owen Ng, Teixeira-Pinto, Anh Kieu, Anita Van Zwieten, Anoushka Krishnan, Kirsten Howard, Wai H. Lim, Jeremy R. Chapman, Simon D. Roger, Michael J. Bourke, Shaundeep Sen, Steven J. Chadban, Carol A. Pollock, Allison Jaure, Jonathan C. Craig, Jean Yang, Germaine Wong

Research outputs 2022 to 2026

Key Points: Dialysis linked with poorer quality of life compared with transplant patients and patients with CKD. Quality of life trends were similar in both domain-specific and overall quality-of-life measures. Background: There are sparse data about the change in health-related quality of life (HRQoL) with the temporal progression of CKD. In this study, we assessed the association between change in CKD stages, overall and domain-specific quality of life and determined the factors that were associated with this change. Methods: Data were sourced from a multicenter study that included 1290 adult patients aged 18 years and older across six centers in …

Setting Research Priorities For The Use Of Digital Technology In The Self-Management Of Heart Health: The Results Of The James Lind Priority Setting Partnership, Lis Neubeck, Simon Nichols, Nicola Straiton, Louise J. Dunford, Amitava Banerjee, Susan Dawkes, Donna Fitzsimons, Maria Hayes, Alistair Lawson, Abigail A. Lyons, Mary Mcauley, Jill Mclaggan, Richard Mindham, Nicholas L. Mills, Rakesh Modi, Alice Pearsons, Amanda Pitkethly, Fiona E. Strachan, Coral L. Hanson

Research outputs 2022 to 2026

Aims: There are wide inequalities in access to cardiovascular care, and risk factors such as obesity, high blood pressure, and physical inactivity are often not well managed. We aim to identify the most important questions about how digital technologies can help people and their carers prevent cardiovascular disease and improve access to care. Methods and results: A priority setting partnership that aimed to generate a top 10 list of research priorities for the use of digital technology in the prevention and management of heart disease and heart conditions in the UK and Ireland, with equal input by people with lived …

Enhancing Patient Care: The Power Of Librarian-Mediated Literature Reviews, Heather J. Martin, Carrie Grinstead, Danielle Linden

Publications 2026-present

Background: Our health system library fields thousands of requests for literature searches each year in support of research, policy, evidence-based practice projects, and care for individual patients. With fewer library staff than comparable institutions and an engaged, multidisciplinary clinical workforce, we face ongoing pressures to do more with less and to demonstrate our value.

Case Presentation: A 2021 article in the Journal of Hospital Librarianship offered an existing survey and basic project design that we used to assess our impacts. We adapted, with permission, the survey and methods of “Analysis of a Hospital Librarian Mediated Literature Search Service at a …

Shaping The Medical Educators Of Tomorrow: Developing Residents' Teaching And Educational Scholarship Skills, Devang Pastakia, Jen King, Alyssa Schlotman, Ryan Hanson, Kyle Langford, Lauren Starnes, Ryan Wolf, Tara Minor

Presentations

It is widely accepted that residents play an integral role in educating medical students.1 It is estimated that medical students receive approximately one-third of their clinical education from residents.2 It has been demonstrated that good education from residents positively impacts medical student clerkship satisfaction and influences career choices.2 Despite the fact that residents participate in educational responsibilities and many residents want to incorporate medical education into their future careers, residencies often do not have programs that provide a foundation for developing future medical educators.3 Dedicated programs may also serve as an avenue through which residents can explore medical education careers …

Exploring How Parental Involvement Impacts Police Encounters And Delinquent Behaviors Among Black Adolescent Girls, Danielle Porter, Elizabeth A. Otto, Dyamon Brown, Jasmine Alli, Robyn Douglas, Noni Gaylord-Harden

Presentations

Adolescents’ contact with police is a complex outcome that is influenced by both individual behavior and the broader social context. Specifically, while delinquent behavior can lead to more police contact (Crutchfield et al., 2012), hyper-surveillance often occurs in marginalized communities, increasing unjustified police contact for youth of color (Campos-Manzo et al., 2020; Geller, 2021). Indeed, racial disparities in police contact during adolescence persist even after accounting for delinquent behavior (Campos-Manzo et al., 2020; Crutchfield et al., 2012). Thus, it is important to identify factors that may protect Black youth from contact with police. Parental involvement refers to parents’ active and …

Antibiotic-Pathogen Concordance In Pediatric Complicated Community-Acquired Pneumonia, Makenna Steger Md, Marina Dantas Md, Mscr, Berina Karisik Do, Smit Shah, Alaina Burns Pharmd, Jessica Markham

Presentations

Background Complicated community-acquired pneumonia (cCAP)—defined by effusion, empyema, abscess, cavitation, or necrosis—is associated with worse outcomes than uncomplicated pneumonia. Methicillin resistant Staphylococcus aureus (MRSA) data in cCAP are limited and often merged with uncomplicated cases. Although guidelines recommend MRSA coverage only in select cases, it is empirically used in >70% of encounters. Lack of pathogen identification likely drives overuse due to diagnostic uncertainty. Clarifying Member of AAP, APA, APS, SPR, ASPN, or PIDS? PIDS JM Jessica Markham, MD, MSc Position: Associate Professor of Pediatrics Organization: Children's Mercy Hospitals and Clinics Email: [email protected] Role: Co-Author Disclosure Status: Complete Disclosure: Nothing to …

Alternative Anticoagulation Strategies For Heparin-Intolerant Patients Undergoing Cardiopulmonary Bypass: A Scoping Review Of Patient Outcomes, Zachary Nelson

Student Works

Background/Introduction: Heparin intolerance, most notably heparin-induced thrombocytopenia (HIT), presents a major clinical challenge during cardiopulmonary bypass (CPB), where systemic anticoagulation is essential for safe circulation through the extracorporeal circuit. While several alternative anticoagulants have been described, there is limited consensus regarding their safety, dosing, and outcomes. The objective of this study was to map existing evidence describing alternative anticoagulation strategies for heparin-intolerant adult patients undergoing CPB and to summarize reported patient outcomes, dosing strategies, and intraoperative management considerations.

Methodology: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) …

Complex Iliac Artery And Iliocaval Venous Reconstruction Using Temporary, Redundant Graft To Facilitate Resection Of Recurrent Metastatic Sex Stromal Tumor, Shah-Jahan M Dodwad, Blaz Podgorsek, Ezra Koh, Taha S Zaidi, Justin E Bird, Shalin S Patel, Thanila A Macedo, Gustavo S Oderich

Faculty, Staff and Student Publications

We report a complex case of recurrent, metastatic sex cord stromal tumor involving the pelvic vasculature and spinal nerves. Posterior and anterior approaches were required with redo iliac artery reconstruction using a temporary, redundant aortoiliac to right external iliac artery graft and iliocaval venous reconstruction. After completion of tumor resection from nerve structures, reconstruction of the right iliac veins was completed and the redundant aortoiliac arterial graft was shortened. The redundant graft minimized ischemia time, enabling meticulous dissection and tumor removal. This case underscores the importance of multidisciplinary collaboration in managing rare, aggressive malignancies with complex vascular and neural involvement.

Adults And Adolescents With High-Intensity Neurologic Impairment Hospitalized At Children’S Hospitals, Charles Maloy, Matt Hall, Joanna Thomson, Jean-Baptist Lepichon, Henry T. Puls

Posters

Introduction: Children with high-intensity neurologic impairment (HINI) account for a sizeable proportion of inpatient resources. As survival into adulthood for children with medical complexity increases, children’s hospitals will likely admit adults with HINI. Understanding adult HINI hospitalization patterns is necessary to develop effective care strategies for this population. Objective: Compare characteristics of adults and adolescents with HINI hospitalized at children’s hospitals and describe hospital-level variation in hospitalizations for adults with HINI. Methods: This retrospective cross-sectional study included discharges of patients with HINI aged 12-29 years from 41 children’s hospitals in the Pediatric Health Information System between 2022-24. Hospitals were excluded …

Variation In Dexamethasone Prescribing Practices For Pediatric Asthma Exacerbations In Acute Care Settings, Hannah Reilly, Natalie J. Kane, Sian Best, Mark A. Hoffman, Kathryn Kyler

Posters

No abstract provided.

Embodied Horror: Women And Medical Authority In Video Games, Jocilynn Denise Colombo

Comparative Literature M.A. Essays

Through a critical analysis of interactive horror, this paper argues that video games can function as ethical diagnostic narratives that uniquely expose systemic failures surrounding women’s bodies and medical authority. Focusing on Silent Hill 3 (2003) and Alice: Madness Returns (2011), I examine how these games render harm legible through player participation. By requiring players to move characters through hostile environments and make decisions within systems that simultaneously grant and restrict control, these games foster identification and complicity by positioning players directly within the structures they critique.

While feminist horror scholarship—notably from Julia Kristeva and Barbara Creed—has explored societal anxieties …

Occupational Epidemiology Of Acral Lentiginous Melanoma, Lily Guo, Robin Kikuchi, April W. Armstrong, Suephy C. Chen

Department of Dermatology and Cutaneous Biology Faculty Papers

Acral lentiginous melanoma (ALM) classically presents in glabrous skin. Some studies suggest an association between mechanical stress and ALM development. People working jobs with long periods of standing/walking may be exposed to near-daily mechanical stress. To investigate the relationship between occupation type and ALM development, we performed a retrospective cohort study using Optum’s Clinformatics Database (2007—2023). We compared the risk of ALM in adults with occupational data (n = 9,270,935). Retired patients had the highest prevalence (0.081) and incidence per 1,000,000 person-years (0.514, 95% confidence interval = 0.487—0.542) of ALM. We performed multivariate logistic regression, adjusted for demographics and insurance, …

Disseminated Tuberculosis Presenting With A Nodo-Colonic Fistula In A Newly Diagnosed Hiv-Positive Patient: A Case Report From Tanzania, Samina Somji, Salim Surani, Joshua Ngimbwa, Tevin Kahwa, Frank Swai, Fatema Tayabali, Bishoy Rofaeil

Population Health, East Africa

We present the case of a 35-year-old male with no known comorbidities who presented with chronic gastrointestinal (GI) and constitutional symptoms and was empirically treated with several antibiotics during multiple clinic visits at different health facilities. The laboratory test sent included a stool GeneXpert, which was positive for Mycobacterium tuberculosis (MTB). CT imaging revealed multiple necrotic abdominal and retroperitoneal lymph nodes, hypoenhancing splenic lesions, a nodo-colonic fistula between the necrotic retroperitoneal lymph nodes and the adjacent colon, and a mild left-sided pleural effusion. Colonoscopy demonstrated caseating discharge from the fistulous tract 40 cm from the anal verge, and histology showed …

Beyond Parallel Programmes: A Roadmap For Operational Integration Of Family Planning And Nutrition In Low- And Middle-Income Countries, Marleen Temmerman, Samuel Ojong

Centre of Excellence in Women and Child Health

No abstract provided.

Pseudo-Bartter Syndrome In A Pancreatic Insufficient Infant With Cftr, Dnah9, Lyst And G6pd Variants, Diana Marangu‐Boore, Doris Kinuthia, Janet Maranga, Peter Ngwatu, Joel Lessan, Rita Boateng

Pathology, East Africa

No abstract provided.

World Health Organization Classification Of Tumours Of The Breast 6th Edition 2026, Cecily Quinn, Puay Tan, Kimberly Allison, Edi Brogi, Sunil Lakhani, Stuart Schnitt, Stephen Fox, Shabnam Jaffer, Aysegul Sahin, Shahin Sayed

Pathology, East Africa

The 6th edition of the WHO Classification of Breast Tumours introduces both major and minor changes based on recent advances in our understanding of breast biology, developments in diagnostic modalities, identification of specific molecular targets and new treatment regimens necessitating modifications to pathology reporting and tumour biomarker categorisation. This review summarises the main changes that strive towards a classification of global relevance. In invasive carcinoma, predictive factors increasingly inform modern breast cancer treatment. The 6th edition provides an update on HER2 reporting categories following the DESTINY-Breast 04 and 06 trials. Terminologies used to classify invasive tumours are clarified, with the …

Scoliosis, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Cannabinoid Hyperemesis Syndrome, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Implementation And Costs Of A Food Insecurity Resource Navigation Program For Primary Care Patients With Diabetes And Hypertension In South Carolina, Deeksha Gupta, Darin Thomas, Stella Coker Watson Self Ph.D., Ms, Edward A. Frongillo Jr. Ph.D., Alain H. Litwin, Joseph A. Ewing, Lynnette Ramos-Gonzalez, Lynnette Ramos-Gonzalez

Faculty Publications

Objective

To examine food insecurity resource navigation program costs and how navigation intensity relates to clinical outcomes, healthcare costs, and quality of life (QOL) for diabetes and/or hypertension patients.

Methods

This retrospective study included patients receiving resource navigation (July 12, 2021-December 31, 2022 with twelve-month follow-up) across three primary care practices in South Carolina's largest health system. Participants were 18+ years old (from electronic medical records/Epic), had food insecurity (from Hunger Vital Sign™), and diabetes and/or hypertension (from Epic registries). Matched controls came from food insecurity screening-only practices. Patients in each group (n= 219) had diabetes (9.13%), hypertension …

Improving Bedside Nurse Central Line Policy Compliance And Combating Clabsis, Keyshawna N. Chambers

Doctor of Nursing Practice Final Project Abstract

Central line-associated bloodstream infections (CLABSIs) are a problem, both globally and locally at this 20-bed pediatric cardiovascular ICU in Houston, TX. Bedside nursing staff had gaps in knowledge of central line policies and were often unaware of when dressings needed to be changed. This posed a significant concern, as this nosocomial infection is among the most life-threatening and costly complications in healthcare. Leadership attempted to correct this issue with weekly multidisciplinary rounds, but with high turnover, this was not a long-term fix. This quality improvement project aimed to increase central line policy compliance among bedside nursing staff to 93%, from …

The Use Of A Safety Screening Tool To Improve Sedation Holiday Compliance And Nurse Confidence, Shelby Marchisio

Doctor of Nursing Practice Final Project Abstract

Purpose

This project sought to evaluate the impact of a safety screening tool on sedation holiday compliance and nurse confidence.

Background

This project was conducted within a 42-bed intensive care unit at a large academic hospital in Houston, Texas. Despite having a nurse-led sedation holiday protocol, compliance averages varied from 50-85%. In alignment with evidence-based practice, it was determined that integrating a safety screening tool into the sedation holiday process may improve compliance.

Methodology

The FADE Model for Quality Improvement guided project development. An anonymous survey was conducted using Likert-scale ratings to assess nursing perceptions and confidence related to sedation …

Reduction Of Waste And Cost In A Cardiac Intensive Care Unit, Jincy C. Skaria

Doctor of Nursing Practice Final Project Abstract

Purpose:
To reduce medical supply waste and associated costs in a Cardiac ICU using a standardized supply cart system.
Background:
Pre-packed post-operative recovery kits were routinely opened for all admissions in the Cardiac ICU, resulting in disposal of unused supplies due to infection control and single-use policies. This practice contributed to avoidable waste, increased costs, and poor resource stewardship.
Methodology:
This quality improvement project was conducted in a 20-bed Cardiac ICU from September 28 to December 6, 2025. The intervention replaced routine opening of full recovery kits with selective retrieval of supplies by nurses from a standardized cart located outside …

Restoration Of Dental Implants With Screw-Retained Crowns: Optimizing Contact Area Geometry To Prevent Food Impaction, John S. Mamoun D.M.D.

The New York State Dental Journal

A single-unit, screw-retained fixed partial denture or crown, made for a dental implant, may show food impaction between the screw-retained crown and an inter-proximal tooth surface. This restorative error may be due to an open contact or a large interproximal embrasure space volume between the screw-retained prosthesis and an interproximal tooth surface. Food impaction may also occur due to the contact plane of the restoration being parallel with the contact plane of the neighboring tooth instead of a more correct contact plane geometry where both interproximal contact planes converge slightly towards each other to form a “triangular” embrasure space. These …

Laser-Assisted New Attachment Procedure: A Review, Divya Khanna B.D.S., M.D.S.

The New York State Dental Journal

Periodontal treatment modalities have evolved substantially to evidence-based minimally invasive treatment options. Lasers have proved to be an effective tool by providing a myriad of benefits and advantages while eliminating many of the negative sequelae that have been historically associated with conventional pocket elimination surgery. Laser-assisted new attachment procedure (LANAP) is a well-defined treatment protocol that has been validated with human histology and has demonstrated both short- and long-term success. LANAP has proven to be an effective, safe and predictable treatment option for achieving regeneration and new attachment formation, leading to favorable clinical outcomes, improved patient compliance and acceptability.

Resolution Of Severe Lateral Open Bite With Surgically Enhanced Orthodontic And Myofunctional Therapies, Daniel Kuncio D.D.S., Maria Karpov D.M.D.

The New York State Dental Journal

Patients often present to our practices with dental relapse of previous orthodontic treatment. Many times, the underlying skeletal and/or functional problems leading to the malocclusion were not addressed, causing the teeth to revert to their initial positions, even with good retainer wear. This patient presented with a severe lateral open bite and complained of problems chewing on his right side.

Previous orthodontic treatment with fixed orthodontics appliances and vertical elastics proved to be unstable. We recommended a treatment plan with surgically assisted rapid palatal expansion (SARPE) to correct the skeletal maxillary constriction and provide more tongue space, followed by surgically …

Dental Offices Subject To New Legal Mandates, Lance Plunkett Jd, Llm

The New York State Dental Journal

Several new workplace laws, applicable to dental practices, have been enacted, as New York continues its aggressive push in the employment law arena.

Heroes Of Medicine In The Rio Grande Valley: Documentary Interview With Dr. Nelson Mata, Nelson Mata, Aidan Mata

Heroes of Medicine in the Rio Grande Valley

Dr. Nelson Mata is a physician who has conducted his practice of internal medicine for 32 years. He has always been fascinated by biology, and when he was only 10 years old, he asked for a microscope for Christmas. Raised in a family of three physicians, he got to see firsthand what it means to help others. Originally living in Dominican Republic where he studied medicine, he went to fulfill his residency program in New York. Later, he began his practice here in the Rio Grande Valley where doctors who could speak Spanish were needed. He saw it as an …

Heroes Of Medicine In The Rio Grande Valley: Documentary Interview With Dr. Cynthia Cavazos Gonzalez, Cynthia Cavazos Gonzalez, Raquel Elena Orellana

Heroes of Medicine in the Rio Grande Valley

Cynthia Cavazos Gonzalez PhD is an Associate Professor of Clinical Practice at UTRGV in Edinburg, Texas and she is the clinic director of the UTRGV Psychology training clinic. She completed a doctoral degree in Clinical Psychology from California School of Professional Psychology in Fresno, California. Her doctoral degree is in Clinical Psychology with a major specialization in Neuropsychology and minor specialization in Health Psychology. She completed an APA-accredited pre-doctoral internship at UTMB in Galveston with a major emphasis in hospital consultation, outpatient psychotherapy, and psychological and neuropsychological evaluations with diverse populations. She completed an informal neuropsychology post-doctoral residency in Texas …