Medicine and Health Sciences Commons^™

Deprescribing Following Access To Lifestyle Treatment: A Retrospective Chart Review Of Primary Care Outcomes In Patients With Type 2 Diabetes, Yoav Jacob, Kara L Staffier, Samveda Menon, Puja B Gandhi, Joeita F Macfield, Gia Merlo, Stefanie M Meyer, Shivani S Patel, Caroline Rhéaume, Madeline Watson, David Donohue, Wayne S Dysinger, Micaela C Karlsen

Faculty, Staff and Student Publications

Background: Among individuals with type 2 diabetes (T2D), lifestyle improvements can restore glycemic control, yet few studies have examined deprescribing in settings where it was necessitated by improvements in health. This study aimed to (1) identify instances of medication deprescribing among adults with T2D in a primary care setting where patients had access to lifestyle medicine (LM), (2) document lifestyle changes among deprescribed patients, (3) assess changes in body mass index (BMI), glucose, and hemoglobin A1c (HbA1c) following deprescribing, and (4) assess the safety of deprescribing in the context of LM-informed care by identifying adverse events.

Methods: A …

Functional And Structural Basis Of A Hypermorphic Trpc3 Variant, Briar Bell, Angela M Jaramillo-Granada, Luis O Romero, Irene A Gutierrez, Venkata K P S Mallampalli, Guizhen Fan, Sameer Varma, Matthew L Baker, Irina I Serysheva, Valeria Vásquez, Julio F Cordero-Morales

Faculty, Staff and Student Publications

Cerebellar ataxias are characterized by impaired motor coordination resulting from neuronal dysfunction within the cerebellum. The mechanisms underlying this pathology and its cerebellar-specific neurodegeneration remain unknown. We uncover how a gain-of-function canonical transient receptor potential member 3 (TRPC3) mutation, coupled with a cerebellum-specific isoform, stabilizes the channel’s open state, resists the leading inhibitor Pyr3, and drives calcium-dependent cell death. Restoring calcium homeostasis by expressing a Purkinje cell calcium pump improves cell viability. Transgenic expression of the TRPC3 hypermorphic variant in Caenorhabditis elegans induces neurodegeneration, confirming its pathogenicity across species. Cryo–electron microscopy and molecular simulations reveal the structural basis for the …

Social Isolation And Firearm Secure Storage In The Usa: Results From The 2022 Brfss, Alexander Testa, Daniel Semenza, Dylan B Jackson, Karyn Fu, Sandra Mckay, Kyle T Ganson, Jason M Nagata, Jack Tsai

Faculty, Staff and Student Publications

Background: Firearm secure storage (ie, storing firearms unloaded and locked) is recommended to reduce unintentional injuries and suicides. However, the relationship between psychological states, such as social isolation, and firearm secure storage practices is under-researched.

Methods: Data are from 7136 individuals with firearms in their households from the 2022 Behavioral Risk Factor Surveillance System. Multinomial logistic regression was used to explore the relationship between social isolation and firearm storage.

Results: Among respondents, 71.6% reported storing firearms unloaded, 14.2% stored firearms loaded and locked and 14.2% stored firearms loaded and unlocked. Most respondents reported feeling 'never' (40.7%) or 'rarely' (33.3%) socially …

Impact Of Who Aware Antibiotic Handbook Training On Antibiotics Prescribing Knowledge Among Private Primary Care Providers: A Vignette-Based, Prep-Post Pilot Study In Patna, India, Poshan Thapa, Prachi Shukla, Chandrashekhar Joshi, Sena Sayood, Pradeep Kumar Sinha, Diwash Timilsina, Mili Dutta, Madhukar Pai, Samira Abbasgholizadeh Rahimi, Sumanth Gandra

2020-Current year OA Pubs

INTRODUCTION: Inappropriate antibiotic prescribing is a major concern in low- and middle-income countries (LMICs), particularly at the primary care level. The WHO AWaRe Antibiotic Handbook was introduced to promote rational antibiotic use, yet its real-world feasibility and potential impact remain underexplored. Our study evaluated the impact and usefulness of the WHO AWaRe Handbook training among private primary care providers (PCPs) in Patna, India.

METHODS: We conducted a pre-post pilot study among 145 private PCPs (40 formal PCPs (FPs) and 105 informal PCPs (IPs) in Patna, India. Participants received training from an infectious disease physician on the WHO AWaRe Antibiotic Handbook. …

Energetic Diversity In Retinal Ganglion Cells Is Modulated By Neuronal Activity And Correlates With Resilience To Degeneration, Zelun Wang, Christopher Zhao, Shelly Xu, Minglei Zhao, Sean Mccracken, Rajendra S Apte, Philip R Williams

2020-Current year OA Pubs

Neuronal function requires high energy expenditure that is likely customized to meet specific signaling demands. However, little is known about diversity of metabolic homeostasis among divergently-functioning types of neurons. To this end, we examined retinal ganglion cells (RGCs), a population of closely related, yet electrophysiologically distinct excitatory projection neurons. Using in vivo 2-photon imaging to measure ATP with single cell resolution, we identified differential homeostatic energy maintenance in the RGC population that correspond to distinct RGC types. In the presence of circuit activity, the most active RGC type (Alpha RGCs), had lower homeostatic ATP levels than other types and exhibited …

Mouse White Matter Matters: Cortical Origins And Spatial Organization Of Mouse White Matter Tracts, Sofia D Gordeev, Melissa Franch, Sarah R Heilbronner

Faculty, Staff and Students Publications

White matter—the fundamental structure underlying network connectivity—lies at the heart of the brain’s computational power. White matter is organized into fiber tracts, or bundles, in both human and nonhuman primate brains. These bundles consist of long-range axonal projections with a set of shared origin and termination points and exhibit a predictable organization. However, the organization of white matter in the mouse brain remains relatively unknown. This knowledge gap is surprising given the central role of mice in neuroscience, with mouse brains serving as the dominant model for transgenics, in vivo calcium imaging, and circuit manipulation. To address this gap, we …

3'Utr Mapping Reveals Alternative Polyadenylation In Right Ventricular Failure, Rahul Neupane, Kartiga Natarajan, Erik E Suarez, Henry J Pownall, Kai-Lieh Huang, Eric J Wagner, Ajay Kumar Verma, Rambabu Majji, Hari Krishna Yalamanchili, Ashrith Guha, Rajarajan A Thandavarayan

Children’s Nutrition Research Center Staff Publications

No abstract provided.

High Prevalence Of Criminal Legal Involvement Among Non-Fatally Injured Ed Patients - An Exploratory Retrospective Observational Cohort Analysis, Vidya Eswaran, Raphael Cohen, Taylor Kaser, Alysse G Wurcel, Michael Mancini, Kateri Chapman-Kramer, Nicholas Szoko, Keyria Page, Melik Coffey, Kristen Mueller

2020-Current year OA Pubs

BACKGROUND: Individuals who have been incarcerated are at high risk of death by homicide after release from carceral settings. Our study aimed to assess the prevalence of criminal legal system involvement (CLSI) among non-fatal violently injured patients enrolled in a hospital-based violence intervention (HVIP) program and describe demographic and clinical characteristics specific to this population.

METHODS: This is an exploratory retrospective cohort study of all patients enrolled in the St. Louis, Missouri based HVIP, Life Outside of Violence (LOV), between 08/15/2018 and 12/31/2024. LOV enrolls patients aged 8-30 who receive violent injury care at a partner hospital. We collected data …

Effective Spectrum-Based Antibiotic Resistance Index For Monitoring Resistance In Gram-Negative Bacilli, M Cristina Vazquez Guillamet, Alice Bewley, Nicole J Tarlton, Reid Goodman, Michael J Durkin, Michael Bernauer, Meghan Brett, Kevin Hsueh, Cristian Bologa, George Turabelidze, Andrew Atkinson, Victoria J Fraser

2020-Current year OA Pubs

BACKGROUND: Antimicrobial resistance (AMR) is a growing public health threat, and we currently lack accurate measures to track and trend this resistance. We developed the antibiotic resistance index (ARI) that aggregates resistance of Gram-negative bacilli (GNB) into a single metric which can be tracked across healthcare settings and over time.

METHODS: Culture data were collected from adult patients who met the CDC adult sepsis event criteria across 10 Barnes-Jewish HealthCare (BJC) hospitals between January 2018 and December 2023. An antibiotic's effective spectrum (AES) was calculated as the ratio of susceptible GNB to all identified GNB. The ARI was calculated as …

Interview With Orca Award Winner David Hage, Unl Chemistry; Drug-Protein Interactions, Mark Griep, David Hage

UNL ORCA Interview Series

Prof. David Hage was awarded the ORCA in 2018. He was born in La Crosse, Wisconsin, and earned a bachelor’s in chemistry at the University of Wisconsin in La Crosse. Next, he earned a doctorate from Iowa State University and did postdoctoral work at the Mayo Clinic in Rochester, Minnesota. In 1989, he joined UNL as an assistant professor of chemistry and quickly rose through the ranks. He has won many awards and, for the past 13 years, has been the James Hewet University Professor of Chemistry. Allow me to share some remarkable facts about Dave before we get into …

Dyadic Internalized Stigma, Resilience, And Psychological Distress Among People With Hiv And Their Family Members: An Actor-Partner Interdependence Mediation Model Analysis, Fanghui Shi, Xueying Yang, Shan Qiao Ph.D., Cheuk Chi Tam Ph.D., M.S., M.A., Shuaifeng Liu, Yuejiao Zhou, Xiaoming Li Ph.D.

Faculty Publications

Despite robust evidence showing the mediation role of psychological resilience in the impacts of HIV-related stigma on psychological distress, most studies were conducted from an intrapersonal perspective. Limited studies have examined the dyadic effects of HIV-related stigma and resilience on psychological distress for people with HIV (PWH) and their family members. This study aimed to explore the actor-partner effect and the mediation role of resilience in the relationship between internalized stigma and psychological distress among PWH and family members dyads. Between October 2023 and December 2023, a total of 800 PWH-family member dyads were recruited from two urban cities and …

A Livelihood Intervention Improved Nutritional, Mental Health And Sexual Health Outcomes Among Hiv-Affected Adolescents In Western Kenya: Results From The Shamba Maisha Randomised Controlled Trial, Sheri D. Weiser, Lila Aziz Sheira, Pauline Wekesa, Jennifer Monroe Zakaras, Edward A. Frongillo Jr. Ph.D., Elly Weke, Jason M. Nagata, Amy A. Conroy, Marguerita Lightfoot, Torsten B. Neilands, Lisa M. Butler, Elizabeth A. Bukusi, Craig R. Cohen, Maricianah Atieno Onono

Faculty Publications

Introduction Interventions that address household-level factors, including food insecurity (FI) and poverty, may reduce HIV risk and improve sexual and reproductive health (SRH) among adolescent girls and young women (AGYW).

Methods This cluster randomised controlled trial in Kenya assessed AGYW living in households of adults enrolled in Shamba Maisha (SM). SM was a multisectoral agricultural livelihood intervention designed to improve HIV health. At the trial end, we used linear and logistic regressions to compare differences between the intervention and control arms in FI, and mental health among AGYW-caregiver pairs and SRH outcomes among the AGYW, accounting for clusters with robust …

Socioeconomic Disparities In Readmission Outcomes And Cardiac Procedures Among Atrial Fibrillation Hospitalizations, Muhammad U. Almani, Muhammad Yousuf, Noor Fatima, Muhammad Q. Ullah, Muhammed Arshad

Einstein Health Papers

Introduction: Atrial fibrillation (AF) remains one of the leading dysrhythmias incurring hospitalization. We set out to determine the impact of socioeconomic status (SES) on in-hospital cardiac procedures and the readmission outcomes in patients with AF. Methods: The National Readmission Database (NRD) was searched for adults with a primary diagnosis of AF between 2010 and 2019. We determined unplanned AF-specific readmission within 30 days. Median neighborhood household income was assessed by patient zip code as quartiles: low income (Q1), middle income (Q2), upper-middle income (Q3), and high income (Q4). Differences in in-hospital cardiac procedures during the index hospitalization and probability of …

Donor Sex And Platelet Storage Change The Therapeutic Effects Of Platelet-Derived Extracellular Vesicles On Endothelium, Mandeep Kaur, Malvika Gupta, Sowmya Shree Gopal, Charles E. Wade, Jessica C. Cardenas, Amit K. Srivastava

Cardeza Foundation for Hematologic Research

Platelet-derived extracellular vesicles (PEVs) play an active role in vascular protection and repair and are being explored as a viable alternative to platelet therapy. Because platelet function and stability are shaped by donor sex and storage conditions, these same factors are likely to influence the PEVs they release. Understanding these influences is key to developing PEVs into a safe and dependable therapeutic option. In this study, we investigated how donor sex and platelet storage affect the therapeutic properties of PEVs. To address this, PEVs were isolated from platelets of healthy male and female donors. Platelets were either processed immediately after …

What Factors Influence Health Professions Trainees’ Preferences For Employment In Rural Appalachia? A Qualitative Study To Inform The Design Of A Discrete Choice Experiment, Chris Gillette, Jan Ostermann Ph.D., Aylin A. Aguillar, Sarah O'Neal, Chris Everett, Dawn Caviness, Esita Patel, Laiton Steele, Dawn Goel, Quazi Minhaz Tabassum

Faculty Publications

Optimizing the geographic allocation of health care providers has the potential to improve health care access and health outcomes for rural populations. To inform the design of a discrete choice experiment (DCE) survey to elicit health professions trainees' preferences for rural practice, this formative research aimed to: (1) elicit factors that influence job selection among health profession trainees, including medical residents physician assistant (PA) and nurse practitioner (NP) students, (2) identify how these trainees evaluate trade-offs for rural job placement and (3) inform attribute selection for inclusion into a future DCE to identify health professions trainees’ preferences for rural practice. …

Plastic Deformation Of The Pediatric Forearm: Recognition, Radiographic Measurement, And Management., Caitlin Wetzel, Matthew Rohl, Taylor Manes, Allen Kadado

Ambulatory and Primary Care Articles

Pediatric forearm bowing fractures, also known as plastic deformation fractures, are a clinically important but often underdiagnosed injury pattern. These fractures usually occur from longitudinal compressive forces such as falls on an outstretched hand, causing plastic deformation that exceeds the elastic limit of pediatric bone. Patients often present with nonspecific symptoms like pain, swelling, and limited pronation-supination, and these injuries can be subtle on radiographs. Using standardized measurement methods, such as the percentage of radial bowing relative to total bone length, can improve diagnosis; values over approximately 10% of radial length are considered suggestive of pathological bowing. Missing or delaying …

Practice Patterns And Inpatient Outcomes In Lung Abscess: A Cross Sectional Study, Saikou Saidy, Ali Iqbal, Saqib H. Baig

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Background: Lung abscess is typically managed with antibiotics, but drainage procedures are sometimes performed when there is inadequate clinical response or when source control is needed. Real-world inpatient practice patterns remain incompletely described in contemporary U.S. data. Our aim was to evaluate national inpatient practice patterns, predictors of procedural intervention, and associated in-hospital outcomes and resource utilization among patients hospitalized with lung abscess managed conservatively, with bronchoscopic drainage, or with percutaneous drainage.

Methods: Using the National Inpatient Sample (NIS) (2016–2018), we identified adult (18 years and older) hospitalizations with a principal diagnosis of lung abscess [International Classification of Diseases, 10th …

Nerandomilast In Progressive Pulmonary Fibrosis: Data From The Whole Follow-Up Period Of The Fibroneer-Ild Trial, Marlies S Wijsenbeek, Shervin Assassi, Arata Azuma, Vincent Cottin, Anna-Maria Hoffmann-Vold, Toby M Maher, Fernando J Martinez, Justin M Oldham, Luca Richeldi, Claudia Valenzuela, Hui Gu, Ivana Ritter, Susanne Stowasser, Michael Kreuter

Faculty, Staff and Student Publications

Background: In the FIBRONEER-ILD trial in patients with progressive pulmonary fibrosis (PPF), nerandomilast 9 mg bid and 18 mg bid reduced the decline in forced vital capacity at week 52 compared with placebo (the primary endpoint). We assessed the effects of nerandomilast up to the final database lock.

Methods: Time to first acute exacerbation of ILD, hospitalisation for respiratory cause, or death (key secondary endpoint) and other time-to-event endpoints were assessed.

Results: 1176 patients, of whom 512 were taking background nintedanib, received nerandomilast or placebo. At final database lock, mean (sd) exposure to trial medication was 15.1 (5.7) months and …

The Development Of A Framework To Classify Medication Deprescribing Among Patients With Type 2 Diabetes In Primary Care Practices, Puja B Gandhi, Yoav Jacob, Joeita F Macfield, Gia Merlo, Stefanie M Meyer, Shivani S Patel, Caroline Rhéaume, Kara L Staffier, Madeline Watson, Micaela C Karlsen

Faculty, Staff and Student Publications

No abstract provided.

An Integrated Germline And Somatic Genomic Model For Coronary Artery Disease, Xiong Yang, Min Seo Kim, Xinyu Zhu, Md Mesbah Uddin, Tetsushi Nakao, So Mi Jemma Cho, Satoshi Koyama, Tingfeng Xu, Laurens F Reeskamp, Rufan Zhang, Zhaoqi Liu, Yunga A, Paul S De Vries, Ramachandran S Vasan, Eric Boerwinkle, Alanna C Morrison, Bruce M Psaty, Russell P Tracy, Susan R Heckbert, Michael H Cho, Jeong H Yun, Nicholette D Palmer, Donald W Bowden, Joanne M Murabito, Daniel Levy, Nancy L Heard-Costa, George T O'Connor, Lewis C Becker, Brian G Kral, Lisa R Yanek, Laura M Raffield, Bertha Hidalgo, Jerome I Rotter, Stephen S Rich, Kent D Taylor, Wendy S Post, Charles Kooperberg, Alexander P Reiner, Braxton D Mitchell, Sharon L R Kardia, Jennifer A Smith, Patricia A Peyser, Lawrence F Bielak, Dong Keon Yon, Hong-Hee Won, Donna K Arnett, Albert V Smith, Stacey B Gabriel, Patrick T Ellinor, Nhlbi Trans-Omics For Precision Medicine (Topmed) Consortium, Pradeep Natarajan, Minxian Wang, Akl C Fahed

Faculty, Staff and Student Publications

Multiple germline and somatic genomic factors are associated with risk of coronary artery disease, but there is no single measure of risk that integrates all information from a DNA sample. To address this gap, we develop an integrated genomic model that includes six germline and somatic genetic drivers for coronary artery disease, including polygenic risk score, genetically-proxied proteomic/metabolomic risk scores, and clonal hematopoiesis of indeterminate potential. We evaluated its predictive power in the UK Biobank (N = 391,536), and validate it using data from the TOPMed program (N = 34,177). The 10-year coronary artery disease risk based on the integrated …

Monitoring Relapse In Post-Transplant Acute Myeloid Leukemia Requires Integrated Assessment, With Flow Cytometry Showing The Highest Efficacy, Wei J Wang, Sa A Wang, Hong Fang, Qing Wei, Shimin Hu, Sanam Loghavi, Gheath Al-Atrash, Chenxuan Zang, Peng Wei, Jeffrey L Medeiros, Wei Wang

Faculty, Staff and Student Publications

No abstract provided.

Proposed Standardized Nomenclature For Anomalous Aortic Origin Of A Coronary Artery: An International Multidisciplinary Initiative, Carlos M Mery, Meena Nathan, Christoph Gräni, Rajesh Krishnamurthy, Cristina Basso, Marshall L Jacobs, Julie A Brothers, Massimo A Padalino, Silvana Molossi

Faculty, Staff and Students Publications

Increasing use of advanced noninvasive imaging has provided great anatomic and morphologic details to characterize congenital coronary artery anomalies. Anomalous aortic origin of a coronary artery (AAOCA) is a subtype that may lead to myocardial ischemia with variable clinical manifestations across the lifespan. Management decision making in AAOCA is hindered by anatomic variants of differing physiologic consequences. Several systems of nomenclature have been used that lack uniformity in potentially high-risk morphologic features. The ICAAC (International Coronary Artery Anomalies Collaborative), a group of experts in coronary artery anomalies, proposes a standardized nomenclature to describe anatomy and morphologic features of AAOCA using …

Domains That Influence Underrepresented Community Wellbeing And Engagement: A Literature Review, Nicole Sung, Mei Lin Chen-Lim, Phd, Rn, Ccrc, Aunja Richards, Bis, Florence Ling, Phd

Student Papers, Posters & Projects

Introduction

Inner-city neighborhoods, such as those in Philadelphia, vary in demographics, resources, access, safety, and overall health. Local non-profits that serve these communities require more understanding of the areas they serve to efficiently align resources and meet the local community needs. Community partnerships, including youth in the community, are key informants as they share lived experiences, navigate neighborhood conditions, and identify barriers and priorities.

Outcomes With Single Tremelimumab Regular Interval Durvalumab (Stride) For Unresectable Hepatocellular Carcinoma In The Us Veterans Administration, Shalini Bansal, Priya Amin, Courtney Williamson, Stephen Valerio, David Kaplan

Student Papers, Posters & Projects

Background: HIMALAYA demonstrated that STRIDE (Single Tremelimumab Regular Interval Durvalumab) significantly improved overall survival (OS) compared with sorafenib in participants with unresectable hepatocellular carcinoma (HCC). This retrospective, real-world cohort study evaluated outcomes with STRIDE in veterans with HCC. Methods: Patients diagnosed with HCC between 1 January 2008 and 28 February 2024 who received ≥1 dose of STRIDE for unresectable disease were included. Data were collected from the Veteran Affairs Corporate Data Warehouse. Safety and efficacy were evaluated overall and for subgroups of patients with Child–Pugh A versus Child–Pugh B cirrhosis, viral versus non-viral HCC, and those with versus without prior …

Patiromer For Patients With Heart Failure At Risk Of Hyperkalemia: Care-Hk In Hf Registry, Omar Cantu-Martinez, Stephen J Greene, Khaja M Chinnakondepalli, Stefan D Anker, Biykem Bozkurt, Javed Butler, John G Cleland, Nihar Desai, Diederick E Grobbee, Ellie Kelepouris, Giuseppe Rosano, Tibor Kempf, Martin Schulz, Carla-Maria Brandes, Victoria Donachie, Andrew J Sauer

Faculty, Staff and Students Publications

Background: For patients with heart failure (HF), hyperkalemia (HK) may prevent optimal renin-angiotensin system inhibitor (RASi) use. Randomized trials show that patiromer, a contemporary potassium binder, reduces serum potassium (sK+) concentrations and HK, potentially enabling RASi optimization. We sought to assess the real-world effectiveness of patiromer in facilitating RASi optimization in HF patients at increased risk of HK.

Methods and results: The CARE-HK in HF (Cardiovascular and Renal Treatment in HF Patients with HK or at High Risk of HK) (NCT04864795) was a prospective registry of patients with chronic HF at increased risk of HK (prior or current …

Multimerin1 And Not Galectin-8 Tempers Wnt Signaling To Promote Gastric Chief Cell Differentiation, Xiaobo Lin, Gabriel Nicolazzi, Xuemei Liu, Chinye Nwokolo, Yehiel Zick, José B Sáenz, Jeffrey W Brown

2020-Current year OA Pubs

Galectins are a family of proteins that bind galactose-containing glycans. One member, galectin-8, preferentially binds galactose that contains a terminal sulfate. Aberrant expression and secretion of sulfated glycosylation epitopes, such as 3'-Sulfo-Le

Cbx6-Ca9 Axis: An Epigenetic-Metabolic Vulnerability In Glioblastoma, Keykavous Parang

Pharmacy Faculty Articles and Research

Glioblastoma (GBM) remains one of the most therapeutically recalcitrant malignancies, with median survival rarely exceeding 15 months despite maximal therapy.¹ The hypoxic tumor microenvironment drives treatment resistance through epigenetic and metabolic adaptations.²

In this issue of Molecular Therapy Oncology, the study by Wang et al.³ demonstrates a novel regulatory axis between CBX6 (chromobox 6), a polycomb group protein, and CA9 (carbonic anhydrase 9), revealing how hypoxia-driven epigenetic reprogramming promotes tumor progression and identifying a mechanistically linked pathway for therapeutic intervention in GBM.

The study by Wang et al.3 advances our understanding of how the tumor microenvironment …

Predictors Of Employment Attrition In Lebanon During Multifaceted Crises: The Role Of Chronic Diseases – A National Cross-Sectional Study, Myriam Dagher, Ali Abboud, Ghada E. Saad, Rita Itani, Rindala Fayyad, Hala Ghattas Ph.D., Stephen J. Mccall, Jocelyn Dejong, Malak Ghezzawi, Nisreen Salti, Sasha Fahme, Serena Canaan

Faculty Publications

The COVID-19 pandemic and Lebanon’s ongoing economic crisis exacerbated existing workforce and health disparities. This study explored the predictors of employment attrition during Lebanon’s concurrent crises and examined the association between chronic conditions and employment attrition. This cross-sectional study recruited adults aged 19–64 years residing in Lebanon through random digit dialing (January – July 2024). Data collected included socio-demographics, household characteristics, employment history and characteristics, and self-reported chronic conditions. The outcome was loss of paid employment (employment attrition) during the crises. Predictors were identified through a Least Absolute Shrinkage and Selection Operator (LASSO) regression, and model discrimination and calibration were …

Abnormal Pupils At The Bedside: Rapid Recognition Of Neurologic And Systemic Emergencies In Acute Care Settings., Dawn C Penney, Zoë M Rushetsky, Donald Penney

PCOM Scholarly Works

Background: Pupillary abnormalities are critical bedside findings that may indicate both benign physiologic variation and life-threatening neurologic emergencies. In emergency and urgent care settings, rapid interpretation of pupillary findings is essential for early recognition of intracranial pathology, vascular lesions, toxicologic syndromes, and ocular disease.

Objective: To summarize clinically significant pupillary abnormalities encountered in acute care and propose a structured bedside framework to distinguish benign from emergent etiologies.

Methods: A narrative review of the literature was conducted, focusing on pupillary neuroanatomy, examination techniques, and underlying pathophysiologic mechanisms relevant to emergency practice. Results Key conditions reviewed include physiologic anisocoria, Horner syndrome, Adie …

Before And After The Bottleneck: Pediatric Group A Streptococcal Infections In Houston, Tx, From 2013 To 2023, Misu A Sanson, Maria Gabriela Segura, Aya Aboulhosn, Luis A Vega, Sakina Chinwala, Lauren M Sommer, J Chase Mcneil, Anthony R Flores

Faculty, Staff and Student Publications

Toward the end of the COVID-19 pandemic, many reports described increasing group A streptococcal (GAS) infections. We sought to describe pandemic-associated changes in GAS clinical and molecular epidemiology. GAS isolates were collected from Texas Children's Hospital laboratory from 01 January 2013 to 31 December 2023 and grouped into pre-pandemic (2013-2019) and pandemic (2020-2023) periods. Invasive (INV), skin and soft tissue infection (SSTI), and pharyngeal (PHG) disease types were determined by medical record review. All isolates were emm typed, and nonsusceptibility (NS) to tetracycline, erythromycin, and clindamycin was determined using standard methods. We analyzed 2,717 isolates (pre-pandemic, n = 1,640; pandemic, …