Medicine and Health Sciences Commons^™

The Case For Early Childhood Education As Health And Economic Policy, Jessica N. Wise, Katarina Reyes, Sandra Mckay

Faculty and Staff Publications

Families across the United States are facing significant challenges due to the limited availability and affordability of high-quality early childhood care options for children under the age of 6. Child care access is especially challenging for those seeking to reenter the workforce. Rethinking child care, especially early childhood education, as health care is essential for achieving a better future and economic security for children, families, and caregivers across the U.S.

Exploring The Use Of Bimodal Transcranial Direct Current Stimulation To Enhance Movement In Individuals With Patellofemoral Pain—A Sham-Controlled Double Blinded Pilot Study, Kai-Yu Ho, Connan Wallace, Jeno Aquino, Bryce Broadwell, Makenzie Whimple, Jing Nong Liang

Physical Therapy Faculty Research

Introduction: In individuals with patellofemoral pain (PFP), addressing increased knee valgus during weight-bearing activities typically involves strengthening weak hip muscles. However, recent literature highlights the role of altered descending central control in abnormal movements associated with PFP. While transcranial direct current stimulation (tDCS) has demonstrated the capacity to enhance neuroplasticity, its application targeting the corticomotor function of gluteal muscles in PFP remains unexplored. This study aimed to investigate the effects of combining bimodal tDCS with exercise on frontal plane kinematics in individuals with PFP. The hypothesis was that bimodal tDCS, specifically targeting the corticomotor function of the gluteal muscles, would …

Conducting Comparative Effectiveness, Multisite Palliative Care And Advance Care Planning Trials: Lessons Learned And Future Directions From Pcori-Funded Studies, Areej El-Jawahri, Brittany Waterman, Susan Enguidanos, Lisa Gibbs, Victor Navarro, Maren Olsen, Jennifer Temel, Annette Totten, Corita R. Grudzen

Department of Medicine Faculty Papers

The Patient-Centered Outcomes Research Institute (PCORI) funded multiple large-scale comparative effectiveness clinical trials evaluating palliative care (PC) and advance care planning (ACP) healthcare delivery models. This article provides an overview of the most common barriers our investigative teams encountered while implementing these trials and the strategies we utilized to overcome these challenges, with particular attention to identifying research partners for multisite trials; addressing contracting and regulatory issues; creating a team governance structure; training and engaging study staff across sites; recruiting, consenting, and enrolling study participants; collecting PC and ACP data and study outcomes; and managing multisite collaborations. The goal of …

Fcrider: A Recombinant Fc Nanoparticle With Endogenous Adjuvant Activities For Hybrid Immunization, Changchuin Mao, Karen Eberle, Xiaojie Chen, Yiming Zhou, Jun Li, Hong Xin, Wenda Gao

School of Graduate Studies Faculty Publications

Active immunization (vaccination) induces long-lasting immunity with memory, which takes weeks to months to develop. Passive immunization (transfer of neutralizing antibodies) provides immediate protection, yet with high cost and effects being comparatively short-lived. No currently approved adjuvants are compatible with formulations to combine active and passive immunizations, not to mention their huge disparities in administration routes and dosage. To solve this, we engineered the Fc fragment of human IgG1 into a hexamer nanoparticle and expressed its afucosylated form in Fut8−/− CHO cells, naming it “FcRider.” FcRider is highly soluble with long-term stability, easily produced at high levels equivalent to those …

Mechanistic Study Of Dna Ligase Iv-Mediated Double-Strand Break Repair In Non-Homologous End Joining, Tasmin Naila, Alan E. Tomkinson

Biomedical Sciences ETDs

Non-homologous end joining (NHEJ) is a crucial double-strand break repair pathway in mammalian cells, resolving DNA damage from ionizing radiation and during V(D)J recombination. Although DNA Ligase IV is the only mammalian DNA ligase involved in NHEJ, it functions as a single-turnover enzyme in vitro. Recent cryo-electron microscopy (cryo-EM) studies revealed two LigIV molecules at the NHEJ synapse, supporting the hypothesis that two ligase molecules are needed for DSB repair by NHEJ. This study aims to validate this hypothesis by providing evidence for coordinated ligation at optimal distance and polarity preference for catalytic activity by LigIV. We determined that coordination …

Identify Best Preceptor Strategies For New Graduate Pediatric Float Pool Nurses With Learning Disabilities, Janna Berg

EBP Fellowship

No abstract provided.

Building And Sustaining Flu Vaccine Acceptance And Trust In The Black Community Through Partnerships With Churches, Salons, And Barbershops, Henry Nuss, Lois Privor-Dumm, Chinonso Ukachukwu, Laura Lee Hall

School of Public Health Faculty Publications

Despite the benefits of flu vaccines, Black adults continue to experience lower vaccination rates in the United States. Contributing factors include lack of access to health care and trusted information about vaccines. The National Minority Quality Forum's Center for Sustainable Health Care Quality and Equity collaborated with church pastors, barbers, and hair stylists to disseminate a survey to their communities to assess barriers/facilitators to flu vaccine uptake. The population (n = 262) was mostly Black (93%), female (77%), between the age of 50-64 (39%) and vaccinated (73%). The most common reasons cited by respondents for being vaccinated were personal health, …

Identification Of A Clade-Specific Hla-C*03:02 Ctl Epitope Gy9 Derived From The Hiv-1 P17 Matrix Protein, Samuel Kyobe, Savannah Mwesigwa, Gyaviira Nkurunungi, Gaone Retshabile, Moses Egesa, Eric Katagirya, Marion Amujal, Busisiwe C Mlotshwa, Lesedi Williams, Hakim Sendagire, On Behalf Of The Cafgen Consortium, Dithan Kiragga, Graeme Mardon, Mogomotsi Matshaba, Neil A Hanchard, Jacqueline Kyosiimire-Lugemwa, David Robinson

Faculty, Staff and Students Publications

Efforts towards an effective HIV-1 vaccine have remained mainly unsuccessful. There is increasing evidence for a potential role of HLA-C-restricted CD8+ T cell responses in HIV-1 control, including our recent report of HLA-C*03:02 among African children. However, there are no documented optimal HIV-1 CD8+ T cell epitopes restricted by HLA-C*03:02; additionally, the structural influence of HLA-C*03:02 on epitope binding is undetermined. Immunoinformatics approaches provide a fast and inexpensive method to discover HLA-restricted epitopes. Here, we employed immunopeptidomics to identify HLA-C*03:02 CD8+ T cell epitopes. We identified a clade-specific Gag-derived GY9 (GTEELRSLY) HIV-1 p17 matrix epitope potentially restricted to HLA-C*03:02. Residues …

Treatment Of Acute Myeloid Leukemia In The Community Setting, Taha Al-Juhaishi, Servillano Dela Cruz, Rohan Gupta, Gina Keiffer, Vicki Morrison, Iuliana Shapira, Ashley Woods, Kelly Norsworthy, Romeo Angelo De Claro, Marc Theoret, Ravin Garg, Elizabeth Dianne Pulte

Kimmel Cancer Center Faculty Papers

The treatment landscape for acute myeloid leukemia (AML) is rapidly changing. Many new agents and lower-intensity regimens have been approved and can be safely used by hematologists and oncologists in both academic and community settings. The US Food and Drug Administration (FDA) held a virtual symposium on AML treatment in the community in November 2022. Several members of the FDA, along with practicing hematologists and oncologists in both academic and community settings, participated in the symposium. The goal of the symposium was to discuss challenges and opportunities in the treatment of patients with AML in community oncology settings. A summary …

Cardiac Manifestations And Outcomes Of Covid-19 Vaccine-Associated Myocarditis In The Young In The Usa: Longitudinal Results From The Myocarditis After Covid Vaccination (Maciv) Multicenter Study, Supriya S. Jain, Steven A. Anderson, Jeremy M. Steele, Hunter C. Wilson, Juan Carlos Muniz, Jonathan H. Soslow, Rebecca S. Beroukhim, Victoria Maksymiuk, Xander Jacquemyn, Olivia H. Frosch, Brian Fonseca, Ashraf S. Harahsheh, Sujatha Buddhe, Ravi C. Ashwath, Deepika Thacker, Shiraz A. Maskatia, Nilanjana Misra, Jennifer A. Su, Saira Siddiqui, Danish Vaiyani, Aswathy K. Vaikom-House, M. Jay Campbell, Jared Klein, Sihong Huang, Christopher Mathis, Matthew D. Cornicelli, Madhu Sharma, Lakshmi Nagaraju, Marla Johnston, Et Al

School of Medicine Faculty Publications

Background: We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). Methods: In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤ 30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The …

Multimodal Mixing Convolutional Neural Network And Transformer For Alzheimer’S Disease Recognition, Junde Chen, Yun Wang, Adnan Zeb, M. D. Suzauddola, Yuxin Wen

Engineering Faculty Articles and Research

Early recognition of Alzheimer’s disease (AD) and its precursor state, mild cognitive impairment (MCI), is pivotal in interrupting the progression of the disease and providing suitable treatment. Recent development in deep learning techniques has drawn great research attention for improving the efficacy of AD recognition. However, numerous current methods solely utilize data from a single auxiliary domain, limiting their ability to harness valuable intrinsic insights from multiple domains. To cope with the challenge, this paper is devoted to establishing an innovative multimodal medical data fusion model, termed as MMDF, to perform Alzheimer’s disease recognition. Multimodal data including clinical records and …

Inspire : Vol 7 Issue 9, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums
• Epilepsy Mini fellowship in Doha | Neurology Faculty
• Asia Pacific Digestive Week (APDW) 2024 | Bali
• PSIM & AKU
• Spotlight on Samina Akhtar: Attendee at Lugano Summer School 2024
• Featured Fellow: Sawera Hanif | Instructor
• What Academics are reading?
• Upcoming Events

Single-Cell Chromatin Accessibility Reveals Malignant Regulatory Programs In Primary Human Cancers, Laksshman Sundaram, Arvind Kumar, Matthew Zatzman, Adriana Salcedo, Neal Ravindra, Shadi Shams, Bryan H Louie, S Tansu Bagdatli, Matthew A Myers, Shahab Sarmashghi, Hyo Young Choi, Won-Young Choi, Kathryn E Yost, Yanding Zhao, Jeffrey M Granja, Toshinori Hinoue, D Neil Hayes, Andrew Cherniack, Ina Felau, Hani Choudhry, Jean C Zenklusen, Kyle Kai-How Farh, Andrew Mcpherson, Christina Curtis, Peter W Laird, Cancer Genome Atlas Analysis Network, John A Demchok, Liming Yang, Roy Tarnuzzer, Samantha J Caesar-Johnson, Zhining Wang, Ashley S Doane, Ekta Khurana, Mauro A A Castro, Alexander J Lazar, Bradley M Broom, John N Weinstein, Rehan Akbani, Shwetha V Kumar, Benjamin J Raphael, Christopher K Wong, Joshua M Stuart, Rojin Safavi, Christopher C Benz, Benjamin K Johnson, Cindy Kyi, Hui Shen, M Ryan Corces, Howard Y Chang, William J Greenleaf

Faculty, Staff and Student Publications

To identify cancer-associated gene regulatory changes, we generated single-cell chromatin accessibility landscapes across eight tumor types as part of The Cancer Genome Atlas. Tumor chromatin accessibility is strongly influenced by copy number alterations that can be used to identify subclones, yet underlying cis-regulatory landscapes retain cancer type-specific features. Using organ-matched healthy tissues, we identified the "nearest healthy" cell types in diverse cancers, demonstrating that the chromatin signature of basal-like-subtype breast cancer is most similar to secretory-type luminal epithelial cells. Neural network models trained to learn regulatory programs in cancer revealed enrichment of model-prioritized somatic noncoding mutations near cancer-associated genes, suggesting …

Correction: Facilitators And Barriers To Initiating And Completing Tuberculosis Preventive Treatment Among Children And Adolescents Living With Hiv In Uganda: A Qualitative Study Of Adolescents, Caretakers And Health Workers, Pauline Mary Amuge, Denis Ndekezi, Moses Mugerwa, Dickson Bbuye, Diana Antonia Rutebarika, Lubega Kizza, Christine Namugwanya, Angella Baita, Peter James Elyanu, Patricia Nahirya Ntege, Dithan Kiragga, Carol Birungi, Adeodata Rukyalekere Kekitiinwa, Agnes Kiragga, Moorine Peninah Sekadde, Nicole Salazar-Austin, Anna Maria Mandalakas, Philippa Musoke

Faculty, Staff and Students Publications

No abstract provided.

Novel Cyclic Homogeneous Oscillation Detection Method For High Accuracy And Specific Characterization Of Neural Dynamics, Hohyun Cho, Markus Adamek, Jon T Willie, Peter Brunner

2020-Current year OA Pubs

Determining the presence and frequency of neural oscillations is essential to understanding dynamic brain function. Traditional methods that detect peaks over 1/

A Rapid Non-Invasive Wearable Device For Assessing Cardiac Troponin, William Franklin Peacock, Karina Melissa Soto-Ruiz, Allan S Jaffe, Brian R Tiffany, Simon A Mahler, Brian W Patterson, Alan Hb Wu, Robert Christenson

Faculty, Staff and Students Publications

Background: Chest pain, a common emergency department 35 (ED) presentation, requires rapid evaluation. Optical technology-based non-invasive wearable devices (Infrasensor, RCE, Carlsbad, CA) rapidly and transcutaneously assesses cardiac Troponin I (cTnI).

Objectives: To perform a pilot study describing the performance of the Infrasensor in cTnI defined cohorts.

Methods: This was a 10-hospital prospective observational study in healthy US subjects with a normal cTnI, and in patients with an elevated local cTnI. Healthy subjects were without disease, defined by a negative questionnaire and bloodwork, had a 3-minute Infrasensor measurement and blood samples for high-sensitivity cardiac troponin I (hs-cTnI), n-terminal pro-B-type natriuretic peptide …

Menopausal Hormone Therapy Use Among Postmenopausal Women, Lin Yang, Adetunji T Toriola

2020-Current year OA Pubs

IMPORTANCE: Menopausal hormone therapy (MHT) is the treatment of choice for symptoms of menopause. However, its adoption is hindered by the risk-benefit trade-off in relation to acute and chronic diseases.

OBJECTIVE: To evaluate trends in and correlates of MHT use among postmenopausal women in the US from 1999 to March 2020.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional analysis of MHT use used data from the nationally representative National Health and Nutrition Examination Survey (NHANES). Participants included noninstitutionalized US postmenopausal women from 10 NHANES study cycles (1999-2000 to 2017-March 2020 [pre-COVID-19 pandemic]). Data were analyzed from December 2023 to April …

Evaluation For Mothers' Knowledge Of Childhood Tonsillitis, Ali Tahssen Alwan, Shukiryia Shadhan Chyad, Sahira Ayyed Abdul-Sahib

Maaen Journal for Medical Sciences

Background: the inflammation of the tonsils is known as Tonsillitis; it is a well-known clinical condition that an infection of either virus or bacteria. It significantly affects children especially.

The aim of the present study was to identify knowledge of mother toward childhood tonsillitis and to find the relationship between mothers' knowledge of childhood of tonsillitis and some variables.

Methods: A cross section study design was adopted in order to achieve the objectives of study. data collection began from 17th September 2023 until 30th January 2024. A non-probability convenience sample of 160 mothers were recruited to the study. …

Using Clear Aligners To Correct Severe Unilateral Lower Premolar Tilting By Lower Arch Expansion, Yu-Chen Cheng, Huei-Mei Tsai, Yi-Min Liu, Tzu-Wen Su, Yu-Ling Cheng

Taiwanese Journal of Orthodontics

This case report describes the treatment of a young female adult presenting with a moderate mandibular overgrowth relative to the maxilla. Accompanying malocclusion included procumbent upper anterior teeth, deep overbite, a complete buccal crossbite at the upper left molar, and tilted lower right premolar. The upper dental arch exhibited a tapered form, the lingually blocked-out premolar contributed to a collapsed alveolar ridge. The patient was treated with clear aligners instead of fixed appliances.

Correct The Skeletal Class Iii Malocclusion With Severe Dental Compensation And Lateral Open Bite By Indirect Use Of Maxillary Tads, Jui-Hsien Yang, Jane Kuo, Fu-Hui Tsai, Yun-Yun Wu

Taiwanese Journal of Orthodontics

The case reports a young woman with skeletal Class III (ANB= −0.5°) who was successfully treated with camouflage orthodontics even she already had severe dental compensation. A nonsurgical approach was adopted because of patient and parental concerns regarding surgical risk. Bilateral maxillary temporary anchorage devices (TADs) were inserted at the infrazygomatic crest, and Class III elastics were used to connect the bilateral lower arch canines to the miniscrews during arch leveling. The treatment resulted in a Class I molar relationship and a +3.0 mm overbite and improved the skeletal Class III relationship (ANB =+2.0°); with notable success in lower arch …

Improved Super-Elastic Ti-Ni Alloy Wire For The Treatment Of Angle Class Ii Malocclusion Combined With 3 Lower Incisors And Scissors Bite Case, Yu-Hsiang Chang, Yuan-Hou Chen, Tzu-Hsin Lee, Yu-Cheng Lo, Jian-Hong Yu

Taiwanese Journal of Orthodontics

A 16-year-old male adolescent came to our orthodontic clinic with a chief complaint of poor dental alignment. Clinical examination revealed Angle Class II malocclusion with tooth #12 blocked-in and tooth #41 congenital missing. Large anterior overjet and posterior buccal crossbite between #17 and #47 were also noted. Cephalometric analysis indicated a low mandibular plane angle. To acquire a harmonious arch coordination and to relieve anterior crowding, teeth #14 and #24 were extracted. Mechanism involved intermaxillary elastics for a better intercuspal interdigitation, mechanical stress for tooth #12 alignment, and vertical offset to eliminate antagonistic interference for easy correction of scissors bite. …

Timing Of Orthodontic Treatment (Part I), Ib Leth Nielsen

Taiwanese Journal of Orthodontics

The need and demand for orthodontic treatment has been studied in many countries around the world. Much of the discussion of this topic has centered around who should receive treatment and at what age. The examinations of school children have mostly been done by orthodontists with assistance from residents and outcomes have varied from country to country. In this review we will look at some of these studies and their findings to get a better idea of the size of the problem and what criteria have been used. Much has been said and written about the timing and in recent …

Relationship Between Posterior Cranial Base Inclination And Skeletal Jaw Patterns, Ratna Sugiartati Arif, Maria Purbiati, Krisnawati E. Tarman

Taiwanese Journal of Orthodontics

Introduction: Variations in nasion (N) could influence the measurement of ANB, thus affecting the interpretation of skeletal jaw relationship. Points sella (S) and N represent the anterior cranial base, a crucial role in determining the skeletal jaw patterns. Improper S-N line can affect results of lateral cephalometric analysis, as a highly tilted S-N line relative to the Frankfort Horizontal Plane (FHP) can lead to discrepancies between the analysis results and true morphology. Therefore, alternative methods, such as analysing the posterior cranial base (sella to basion, S-Ba), are needed to establish a diagnosis.

Objective: To determine relationship between posterior …

Strength And Conditioning Habits Of Polish Amateur Endurance Runners, Zbigniew Jost, Maciej Chroboczek

Baltic Journal of Health and Physical Activity

Introduction: Correctly performed Strength & Conditioning (S&C) training is important in terms of improving sports performance. This survey was to check S&C habits among amateur runners in Poland. Materials and Methods: The questionnaire dealt with 1) personal and anthropometric data, 2) advancement / fitness level and 3) training habits, which was correctly filled in by 923 people. The participants were matched to five fitness levels (LG1–LG5) depending on sex (W/M) and the selected distance (5K/10K/Half-Marathon). Results: More than half of the respondents (n = 467, 50.6%) considered S&C as very important. The most frequently used S&C activities were uphill runs …

The Effect Of 6-Week Eeg-Biofeedback Training In Normobaric Hypoxia And Normoxia Conditions On Reaction Time In Elite Judo Athletes, Magdalena Prończuk, Joanna Motowidło, Ewelina Lulińska, Dariusz T. Skalski, Jarosław Markowski, Jan Pilch, Maciej Kostrzewa, Artur Terbalyan, Karol Skotniczny, Adam Maszczyk

Baltic Journal of Health and Physical Activity

Introduction: The purpose of this study was to evaluate the effect of Biofeedback Training in normoxic and normobaric hypoxic conditions on reaction times in judo athletes. Material and methods: The participants in the experimental group underwent thetha/beta1 training under simulated hypoxic conditions in a laboratory equipped with a normobaric hypoxia generation system (LOS-HYP1/3NU, Lowoxygen Systems, Germany), at a simulated altitude of 2500m above sea level (FiO₂ = 15.5%). Each cycle of the study consisted of 15 training sessions. The training sessions lasted for 20 minutes, with 4 sets of 4 minutes each and a 1-minute break in between. In …

Anxiety And Depression Amongst Female Athletes, Dp Golden, Re Obmann, Em Moore

Clinical Practice in Athletic Training

Context: Anxiety (categorized by a feeling of fear, dread, and uneasiness) and depression (mood disorder causing feelings of persistent sadness and loss of interest in things an individual once loved) are two major mental health disorders effecting females considerably who participate in sport. Females are more likely to present with anxiety (55-60%)1 and depression (1.844 times)2 compared to males. The purpose of this study was to examine the prevalence between mental health comorbidities (anxiety and depression), across female athletes aged 18-40. Methods: An anonymous survey was distributed via snowball sampling using social media. Demographic data, Generalized Anxiety Disorder-7 (GAD-7), validated …

Effects Of Sex Hormones And The Menstrual Cycle On Knee Joint Laxity In Physically Active Females: A Critically Appraised Topic, Ae Eicher, Rj Gage, K Park-Braswell

Clinical Practice in Athletic Training

Clinical Scenario: In recent years, females have exhibited increased physical activity and sport participation than ever before. Recent studies have identified a rising incidence rate of ACL injuries and indicate that the risk of ACL tears is greater in females than males. Knee laxity and physiological variation in women during the menstrual cycle have demonstrated increased ligament laxity, therefore, varying hormone concentrations may contribute to changes in ligamentous mechanical properties. Despite these findings, it remains unclear whether fluctuating sex hormone concentrations directly correlate to measurable changes in knee laxity. Clinical Question: How do fluctuations in sex hormones throughout the menstruation …

Individual Goal And Velocity Based Throwing Program For Collegiate Baseball Pitchers With Medial Elbow Injuries, Le Trail, Jm Cline, Ap Jacobsen

Clinical Practice in Athletic Training

Background: A 22-year-old male collegiate baseball pitcher experienced sudden pain in the medial left elbow following feeling a pop when pitching. The pitcher was removed from the competition and was evaluated with a point-of-care ultrasound at the conclusion of the competition. Ultrasound revealed an intact ulnar collateral ligament (UCL) and no edema. Differential Diagnosis: UCL sprain, Wrist flexor strain Treatment: The patient was referred to a primary care sports medicine physician for further evaluation. The physician found no tenderness or laxity at the UCL and ordered an MRI arthrogram for further diagnostic information. MRI revealed a grade II flexor digitorum …

Medical School Watercooler Newsletter - September 5, 2024, Lindsay Hughes

Watercooler Newsletter

This is the Thursday, September 5, 2024 edition of the Frederick P. Whiddon College of Medicine's newsletter -- Watercooler.

Contents include: 

• Senior medical students named to Alpha Omega
• Register now: USA Health Game Day set for Oct. 15
• Emergency general surgeon joins Whiddon COM faculty
• Standardized patients needed for USA Simulation Program
• Mitchell Cancer Institute to raise awareness, funds for GYN cancer research at GO Run

Presentation Of An Accessory Navicular Bone In A Collegiate Women’S Field Hockey Player: A Type 3 Clinical Case Study, N Sutker, J Franco, K Mallory, B Hansberger

Clinical Practice in Athletic Training

Background: The accessory navicular is an extra bone located posterior and medial to the navicular tuberosity. The prevalence of accessory navicular has been reported to be 4 - 21% in the general population though this anatomical variant may often be overlooked during differential diagnosis. This case presents a female collegiate field hockey patient that was initially diagnosed with a midfoot sprain but was later determined to have an accessory navicular bone which required surgical removal. Patient: A 19-year-old female Division I collegiate field hockey patient presented to the athletic training clinic with pain in her left medial foot. The patient …