Medicine and Health Sciences Commons^™

Chronic, Battery-Free, Fully Implantable Multimodal Spinal Cord Stimulator For Pain Modulation In Small Animal Models, Allie J Widman, Taron Bashar, Alex Burton, David Marshall Clausen, Prashant Gupta, Drew K Wolf, Jakayla Folarin-Hines, Maria Payne, John A Rogers, Kathleen W Meacham, Robert W Gereau, Philipp Gutruf

2020-Current year OA Pubs

Spinal cord stimulation (SCS) for chronic pain management is an invasive therapy involving surgical implantation of electrodes into spinal epidural space. While the clinical value and mechanistic action of the therapy is debated considerably in recent years, preclinical chronic studies employing rodent models can provide invaluable insights regarding the balance between efficacy and complications as well as mechanistic understanding of SCS therapy. However, current rodent compatible devices require tethered power delivery or bulky batteries, severely limiting the ability to probe long-term efficacy of SCS therapy. This work introduces a tether-free, small-footprint, fully implantable, battery-free SCS device compatible with rodent models, …

Claustrum Volume Is Reduced In Multiple Sclerosis And Predicts Disability, Nicole Shelley, Bradley Judge, Dmitriy A Yablonskiy, Robert T Naismith, Matthew R Brier, Anne H Cross

2020-Current year OA Pubs

OBJECTIVE: The claustrum is a small, thin structure of predominantly gray matter with broad connectivity and enigmatic function. Little is known regarding the impact of claustrum pathology in multiple sclerosis (MS).

METHODS: This study assessed whether claustrum volume was reduced in MS and whether reductions were associated with specific disability domains. We compared the impact of claustrum volume reductions on neurological disability versus the well-studied thalamus. Data from the 15,793 participants in the MS PATHS study were used for primary analyses. A second cohort of 71 people with MS and healthy controls from our center was used for validation.

RESULTS: …

Masseter Muscle Size In Chronic Parotid Sialadenitis, Erika M Stephens, William E Nesmith, M Allison Ogden, Jolie L Chang

2020-Current year OA Pubs

OBJECTIVE: The relationship between masseter muscle thickness and parotid duct obstruction resulting in recurrent sialadenitis is not well defined. This study aims to evaluate masseter muscle size in patients with chronic sialadenitis of the parotid and compared to patients without parotid sialadenitis.

METHODS: Data was collected retrospectively from patients with symptomatic chronic sialadenitis of the parotid or submandibular glands. Measurements of the masseter and lateral pterygoid muscles were performed on CT or MRI imaging by two investigators who were blinded to the symptomatic gland location. Masseter thickness in the region of the parotid duct trajectory was measured.

RESULTS: Out of …

Corneal Characteristics In Children With Marfan Syndrome With Or Without Ectopia Lentis, Marisa O'Brien, Lawrence Tychsen

2020-Current year OA Pubs

IMPORTANCE: Myopia of Marfan syndrome (MFS) may be ascribed to crystalline lens subluxation, abnormal corneal curvature, and increased globe axial length. Few studies have reported these measures in MFS children who did or did not have ectopia lentis (EL).

OBJECTIVE: To measure eye findings longitudinally in MFS children with and without EL.

METHODS: A prospective, comparative case study was conducted on 24 MFS children (48 eyes). EL necessitated lensectomy and intraocular lens implantation surgery in 16/24 children (mean age 5.6 ± 2.8 years). The remaining 8/24 MFS children (mean age 11.2 ± 4.2 years) had no EL and were phakic. …

Mollusc And Crustacean Consumption In The First 1000 Days: A Scoping Review, Brietta M Oaks, Emmanuel A Gyimah, Eliza Kleban, Kathleen Ragsdale, Lora L Iannotti

2020-Current year OA Pubs

Mollusc and crustacean consumption in the first 1000 d may improve maternal and child health by providing essential nutrients. However, in some contexts, molluscs and crustaceans have been associated with allergies and environmental contamination, potentially leading to adverse health and development outcomes. It is unclear whether the health benefits of consuming molluscs and crustaceans, collectively classified as shellfish in nutrition, are outweighed by the potential risks to pregnant women and children. We conducted a scoping review (PROSPERO: CRD42022320454) in PubMed, Scopus and EBSCO Global Health of articles published between January 2000 and March 2022 that assessed shellfish consumption during pregnancy, …

Scoping Literature Review To Identify Candidate Domains For The Omeract Systemic Lupus Erythematosus Core Outcome Set, Wils Nielsen, Alfred Kim, Et Al.

2020-Current year OA Pubs

No abstract provided.

Protocol For A Multisite, Parallel-Group, Randomized Clinical Trial Comparing A Brief Tele-Cognitive Behavioral Therapy Intervention (Bright) With Attention Control For The Reduction Of Body Image-Related Distress Among Head And Neck Cancer Survivors, Evan M Graboyes, Jessica R Vanderlan, Patrik Pipkorn, Sidharth V Puram

2020-Current year OA Pubs

One in four head and neck cancer (HNC) survivors experience clinically significant body image distress (BID), a devastating psychosocial morbidity that adversely affects quality of life. To date, effective interventions for these patients are lacking. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment), a brief cognitive behavioral treatment (CBT), has shown potential efficacy as a novel treatment paradigm for HNC survivors with BID. The primary objective of this randomized clinical trial (RCT) is to test the hypothesis that BRIGHT improves BID among HNC survivors relative to an Attention Control (AC) intervention. In this multisite RCT, N = …

Nf2 Loss-Of-Function And Hypoxia Drive Radiation Resistance In Grade 2 Meningiomas, Bhuvic Patel, Sangami Pugazenthi, Shree S Pari, Tatenda Mahlokozera, William A Leidig, Hsiang-Chih Lu, Alicia Yang, Kaleigh Roberts, Patrick Desouza, Kyle P Mcgeehan, Diane D Mao, Namita Sinha, Joseph E Ippolito, Sonika Dahiya, Hiroko Yano, Albert H Kim, Et Al.

2020-Current year OA Pubs

BACKGROUND: World Health Organization Grade 2 meningiomas (G2Ms) often recur and resist therapies. Grade 2 meningiomas with histopathological necrosis have been associated with worse local control (LC) after radiation therapy, but the drivers and biomarkers of radiation resistance in G2Ms remain unknown.

METHODS: We performed genetic sequencing and histopathological analysis of 113 G2Ms and investigated the role of genetic and microenvironmental factors on clonogenic survival after ionizing radiation. We performed transcriptional profiling of our in vitro model and 18 human G2M tumors by bulk RNA sequencing as well as 8 G2Ms by single nuclei RNA sequencing.

RESULTS: NF2 loss-of-function (LOF) …

Hepatitis C Treatment Initiation During Hospitalization For People Who Use Drugs: A Narrative Review Of The Literature, Jacob Denkins, Jane Babiarz, Youngyoon Ham, Hayoung Ryu, Brian Ricci, Carissa Williams, Ian Alexander, Kendall Tucker, L Madeline Mccrary, Ximena Levander

2020-Current year OA Pubs

People who use drugs (PWUD) are increasingly acquiring and transmitting hepatitis C virus (HCV) and being admitted to the hospital for often costly non-HCV-related conditions. Traditionally, treatment of HCV has been deferred to the outpatient setting. However, outpatient HCV follow-up can be an arduous process to navigate with resultant gaps in care, especially for PWUD with numerous complex psychosocial and medical comorbidities. Hospitalization presents a key opportunity to initiate treatment, and several institutions have piloted inpatient treatment models with intensive outreach. We conducted a narrative review of peer-reviewed literature (2014-2024) evaluating hospital-based HCV treatment models for PWUD; 6 studies from …

Assessing Neurocognitive Maturation In Early Adolescence Based On Baby And Adult Functional Brain Landscapes, Omid Kardan, Muriah D Wheelock, Jiaxin Cindy Tu, Et Al.

2020-Current year OA Pubs

Adolescence is a period of growth in cognitive performance and functioning. Recently, data-driven measures of brain-age gap, which can index cognitive decline in older populations, have been utilized in adolescent data with mixed findings. Instead of using a data-driven approach, here we assess the maturation status of the brain functional landscape in early adolescence by directly comparing an individual's resting-state functional connectivity (rsFC) to the canonical early-life and adulthood communities. Specifically, we hypothesized that the degree to which a youth's connectome is better captured by adult networks compared to infant/toddler networks is predictive of their cognitive development. To test this …

White Matter Microstructure In School-Age Children With Down Syndrome, Dea Garic, Robert C Mckinstry, Natasha Marrus, Kelly N Botteron, Et Al.

2020-Current year OA Pubs

Down syndrome (DS) is the most common genetic cause of intellectual disability, but our understanding of white matter microstructure in children with DS remains limited. Previous studies have reported reductions in white matter integrity, but nearly all studies to date have been conducted in adults or relied solely on diffusion tensor imaging (DTI), which lacks the ability to disentangle underlying properties of white matter organization. This study examined white matter microstructural differences in 7- to 12-year-old children with DS (n = 23), autism (n = 27), and typical development (n = 50) using DTI as well as High Angular Resolution …

Measuring And Interpreting Individual Differences In Fetal, Infant, And Toddler Neurodevelopment, Halie A Olson, M Catalina Camacho, Natasha Marrus, Et Al.

2020-Current year OA Pubs

As scientists interested in fetal, infant, and toddler (FIT) neurodevelopment, our research questions often focus on how individual children differ in their neurodevelopment and the predictive value of those individual differences for long-term neural and behavioral outcomes. Measuring and interpreting individual differences in neurodevelopment can present challenges: Is there a "standard" way for the human brain to develop? How do the semantic, practical, or theoretical constraints that we place on studying "development" influence how we measure and interpret individual differences? While it is important to consider these questions across the lifespan, they are particularly relevant for conducting and interpreting research …

A Systematic Review And Meta-Analysis Of Social Cognition Among People Living With Hiv: Implications For Non-Social Cognition And Social Everyday Functioning, David E Vance, Rebecca Billings, Crystal Chapman Lambert, Pariya L Fazeli, Burel R Goodin, Mirjam-Colette Kempf, Leah H Rubin, Bulent Turan, Jenni Wise, Gerhard Hellemann, Junghee Lee

2020-Current year OA Pubs

Social cognition-the complex mental ability to perceive social stimuli and negotiate the social environment-has emerged as an important cognitive ability needed for social functioning, everyday functioning, and quality of life. Deficits in social cognition have been well documented in those with severe mental illness including schizophrenia and depression, those along the autism spectrum, and those with other brain disorders where such deficits profoundly impact everyday life. Moreover, subtle deficits in social cognition have been observed in other clinical populations, especially those that may have compromised non-social cognition (i.e., fluid intelligence such as memory). Among people living with HIV (PLHIV), 44% …

Plasma Mtbr-Tau243 Biomarker Identifies Tau Tangle Pathology In Alzheimer's Disease, Kanta Horie, Rama K Koppisetti, Nicolas R Barthélemy, Yingxin He, Chihiro Sato, Brian A Gordon, Hong Jiang, Tammie L S Benzinger, David M Holtzman, John C Morris, Suzanne E Schindler, Randall J Bateman, Et Al.

2020-Current year OA Pubs

Insoluble tau aggregates within neurofibrillary tangles are a defining neuropathological feature of Alzheimer's disease (AD) and closely correlate with clinical symptoms. Although tau pathology can be assessed using tau positron emission tomography, a more accessible biomarker is needed for diagnosis, prognosis and tracking treatment effects. Here we present a new plasma tau species, the endogenously cleaved, microtubule-binding region containing residue 243 (eMTBR-tau243), which specifically reflects tau tangle pathology. Across the AD spectrum in three different cohorts (n = 108, 55 and 739), plasma eMTBR-tau243 levels were significantly elevated at the mild cognitive impairment stage and increased further in dementia. Plasma …

The Compassionate H.E.A.R.T. Of Relationship-Centered Care, Dustin Willis

Loma Linda University Electronic Theses, Dissertations & Projects

The patient-provider interaction (PPI) represents a critical dimension of healthcare delivery that significantly influences clinical outcomes, yet the nuanced dynamics of compassionate care remain operationally elusive. This dissertation presents the Compassionate H.E.A.R.T. (Helping Ease, Alleviate, & Relieve Therapeutically) framework—a novel theoretical model for understanding and enhancing relationship-centered care—and examines its validity, reliability, and therapeutic impact.

Through four interconnected studies, this research explores the multifaceted nature of compassionate care. First, a comprehensive literature review excavates the landscape of patient-provider interactions, highlighting terminological inconsistencies, incomplete theoretical frameworks, and methodological challenges in measuring these ethereal qualities. Second, the Compassionate H.E.A.R.T. model is introduced, …

Tobacco, Alcohol, And Poverty In Lao Pdr Based On National Survey Analysis, Robert M. Semakula

Loma Linda University Electronic Theses, Dissertations & Projects

Tobacco and alcohol use are among the most prevalent and harmful addictive behaviors globally, including in the Lao People’s Democratic Republic (Lao PDR). In Southeast Asia and the Western Pacific, substance use patterns are shaped by cultural, social, economic, policyrelated, and environmental factors. This study aimed to: (1) explore associations between different patterns of alcohol and tobacco use among men and women in Lao PDR, and (2) investigate the effect of poverty on the relationship between alcohol and tobacco use. We conducted a secondary analysis of the 2013 Lao National Adult Tobacco Survey (N = 9,706), a nationally representative sample …

A Meta-Analysis Of Diagnostic Yield And Clinical Utility Of Genome And Exome Sequencing In Pediatric Rare And Undiagnosed Genetic Diseases, Rajshree Pandey, Noemi Fluetsch Brennan, Kalliopi Trachana, Sarah Katsandres, Olaf Bodamer, John Belmont, David L Veenstra, Siyang Peng

Center for Medical Ethics and Health Policy Staff Publications

Purpose: To systematically evaluate the diagnostic yield and clinical utility of genome sequencing (GS) and exome sequencing (ES; genome-wide sequencing [GWS]) in pediatric patients with rare and undiagnosed genetic diseases.

Methods: We conducted a meta-analysis of studies published between 2011 and 2023. To address study heterogeneity, comparative analyses included within-cohort studies using random-effects models.

Results: We identified 108 studies including 24,631 probands with diverse clinical indications. The pooled diagnostic yield among within-cohort studies (N = 13) for GWS was 34.2% (95% CI: 27.6-41.5; I2: 86%) vs 18.1% (95% CI: 13.1-24.6; I2: 89%) for non-GWS, with 2.4-times odds of diagnosis (95% …

Differential Gene Expression Study In Whole Blood Identifies Candidate Genes For Psychosis In African American Individuals, Emma M. Knowles, Juan M. Peralta, A. L. Rodrigue, Samuel R. Mathias, Josephine Mollon, Ana C. Leandro, Joanne E. Curran, John Blangero, David C. Glahn

School of Medicine Publications

Genome-wide association has identified regions of the genome that mediate risk for psychosis. It is possible that variants in these regions confer risk by altering gene expression. This work has predominantly been conducted in individuals of European descent and has focused narrowly on schizophrenia rather than psychosis as a syndrome. In the present study we investigated alterations in gene expression in African American individuals with a range of psychotic diagnoses to increase understanding of the etiology in an underserved population. We performed RNA-seq in whole bloody to survey the transcriptome in 126 patients with a psychosis-spectrum disorder and 217 healthy …

Applying Bloom's Taxonomy In Primary Care Behavioural Health Training, Stacy A. Ogbeide, Yajaira Johnson-Esparza, Deepu George

School of Medicine Publications

Bloom's cognitive learning taxonomy is widely used in medical education. The revised taxonomy published by Kathwohl and colleagues describes the levels in action forms to support learner thinking: Remember, Understand, Apply, Analyse, Evaluate and Create. The taxonomy has been commonly used to design and structure educational goals and objectives. However, most uses occur at the course or rotation curriculum level, whereas applying the taxonomy at the level of individual educational activities remained limited. This article addresses this limitation by applying the taxonomy in daily clinical teaching in Primary Care Behavioural Health education by providing practical clinical teaching examples and encourages …

Impact Of Metabolically Healthy Obesity On Post Percutaneous Coronary Intervention Outcomes In Patients With Acute Myocardial Infarction: A Nationwide Propensity Matched Analysis, Rupak Desai, Adhvithi Pingili, Arankesh Mahadevan, Vishal Reddy Bejugam, Hafeezuddin Ahmed, Vamsikalayan Borra, Adil Sarvar Mohammed, Gayatri Bondi, Shobana Krishnamurthy, Nithya Borra

School of Medicine Publications

Background

Obesity paradox in post-percutaneous coronary intervention (PCI) outcomes among acute myocardial infarction (AMI) patients is a known controversy. However, these studies included patients who had diabetes, hypertension, or hyperlipidemia. We studied relationship between metabolically healthy obesity (MHO—without diabetes, hypertension, or hyperlipidemia) and in-hospital post-PCI outcomes among AMI patients.

Methods

We extracted data from National Inpatient Sample 2020 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for admissions of AMI patients who underwent PCI. We then identified patients with diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity index and Clinical Classifications Software and excluded them. Then, using Elixhauser …

A Scan Of Pleiotropic Immune Mediated Disease Genes Identifies Novel Determinants Of Baseline Fviii Inhibitor Status In Hemophilia A, Marcio Almeida, Vincent P. Diego, Kevin R. Viel, Bernadette W. Luu, Eron G. Manusov, Juan M. Peralta, Satish Kumar, Sarah Williams-Blangero, John Blangero, Tom Howard

School of Medicine Publications

Hemophilia-A (HA) is the X-linked bleeding disorder caused by heterogeneous factor (F)VIII gene (F8)-mutations and deficiencies in plasma-FVIII-activity that prevent intrinsic-pathway mediated coagulation-amplification. Severe-HA patients (HAPs) require life-long infusions of therapeutic-FVIII-proteins (tFVIIIs) but ~30% develop neutralizing-tFVIII-antibodies called “FVIII-inhibitors (FEIs)”. We investigated the genetics underlying the variable risk of FEI-development in 450 North American HAPs (206 and 244 respectively self-reporting black-African- or white-European-ancestry) by analyzing the genotypes of single-nucleotide-variations (SNVs) in candidate immune-mediated-disease (IMD)-genes using a binary linear-mixed model of genetic association with baseline-FEI-status, the dependent variable, while simultaneously accounting for their genetic relationships and heterogeneous-F8-mutations to …

Genetic Analysis Of Psychosis Biotypes: Shared Ancestry-Adjusted Polygenic Risk And Unique Genomic Associations, Cuihua Xia, Ney Alliey Rodriguez, Carol A. Tamminga, Matcheri S. Keshavan, Godfrey Pearlson

School of Medicine Publications

The Bipolar-Schizophrenia Network for Intermediate Phenotypes (B-SNIP) created psychosis Biotypes based on neurobiological measurements in a multi-ancestry sample. These Biotypes cut across DSM diagnoses of schizophrenia, schizoaffective disorder, and bipolar disorder with psychosis. Two recently developed post hoc ancestry adjustment methods of Polygenic Risk Scores (PRSs) generate Ancestry-Adjusted PRSs (AAPRSs), which allow for PRS analysis of multi-ancestry samples. Applied to schizophrenia PRS, we found the Khera AAPRS method to show superior portability and comparable prediction accuracy as compared with the Ge method. The three Biotypes of psychosis disorders had similar AAPRSs across ancestries. In genomic analysis of Biotypes, 12 genes, …

Development Of An Evidence-Based Mentorship Program To Support Historically Underrepresented Communication Sciences And Disorders Undergraduate Students Applying For Graduate Programs In Speech Language Pathology And/Or Audiology, Leannmarie Senat

Dissertations, Theses, and Capstone Projects

Introduction and Background

The professions of Speech-Language Pathology (SLP) and Audiology have had a long-standing history of racial, ethnic, and linguistic disparities among practitioners. In recent years, despite the increase in diversity of the United States population, and research that shows the benefits of increased diversity in healthcare, this lack of representation persists.

Purpose

The current pilot study describes the design, implementation, and evaluation of an evidence-based mentorship program aimed at supporting historically underrepresented undergraduate students in Communication Sciences and Disorders (CSD) at Brooklyn College (BC) to prepare participants who plan to apply for graduate programs in SLP and Audiology. …

June 2025, Swosu Rural Health Center

RURAL ROCKS

• PBM Reform Takes Off in 2025
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Generation Of Personalized Synthetic 3-Dimensional Inlet Velocity Profiles For Computational Fluid Dynamics Simulations Of Type B Aortic Dissection, Richard Gibbs, Xiao Yun Xu

Faculty, Staff and Students Publications

Background: Computational fluid dynamics (CFD) simulations have shown promise in assessing type B aortic dissection (TBAD) to predict disease progression, and inlet velocity profiles (IVPs) are essential for such simulations. To truly capture patient-specific hemodynamic features, 3D IVPs extracted from 4D-flow magnetic resonance imaging (4D MRI) should be used, but 4D MRI is not commonly available.

Method: A new workflow was devised to generate personalized synthetic 3D IVPs that can replace 4D MRI-derived IVPs in CFD simulations. Based on 3D IVPs extracted from 4D MRI of 33 TBAD patients, statistical shape modelling and principal component analysis were performed to generate …

Cross-Institutional Dental Electronic Health Record Entity Extraction Via Generative Artificial Intelligence And Synthetic Notes, Xiaoqian Jiang, Muhammad F Walji, Oluwabunmi Tokede

Faculty, Staff and Student Publications

Background: While most health-care providers now use electronic health records (EHRs) to document clinical care, many still treat them as digital versions of paper records. As a result, documentation often remains unstructured, with free-text entries in progress notes. This limits the potential for secondary use and analysis, as machine-learning and data analysis algorithms are more effective with structured data.

Objective: This study aims to use advanced artificial intelligence (AI) and natural language processing (NLP) techniques to improve diagnostic information extraction from clinical notes in a periodontal use case. By automating this process, the study seeks to reduce missing data in …

Baseline Predictors Of Responders To Auricular Point Acupressure In Chronic Low Back Pain, Claudia M Campbell, Johannes Thrul, Xinran Huang, Paul Christo, Constance M Johnson

Faculty, Staff and Student Publications

Background: Chronic low back pain (cLBP) is a major cause of disability, with varied patient responses to treatments. Auricular point acupressure (APA) has shown potential as a non-pharmacological intervention, but individual responses may differ significantly.

Objective: This study aimed to determine the predictability of baseline characteristics, including functional disability, symptom severity, and treatment expectancy, on clinically significant responses to APA in reducing pain and improving function.

Methods: A secondary analysis was performed using data from a randomized controlled trial with 263 cLBP patients. Participants were randomly assigned to targeted APA (T-APA), non-targeted APA (NT-APA), or to a control group. APA …

Survey Of The Diagnostic, Rehabilitative, Educational, And Inter-Professional Changes In The Profession Of Audiology, Leah Joshowitz

Dissertations, Theses, and Capstone Projects

Background: The profession of audiology has undergone dramatic changes since its inception. A survey of audiologists working in a variety of settings was conducted to gain insight into their perspective on how the scope of audiology practice has changed overtime. Participants responded to an open-ended questionnaire with questions ranging from queries about the expansion of knowledge base in topics such as advanced diagnostics, technological advances, national regulations, educational requirements, and inter-professional collaborations. The implications of the findings regarding the evolution of the current scope of practice and how it can be altered are discussed below.

Methods: An open-ended questionnaire was …

The Ethnobotany And Pharmacology Of Medicinal Plants For Caribbean Women’S Health, Ella Thomas Vardeman

Dissertations, Theses, and Capstone Projects

Approximately 55% of the world’s population lives in cities, and the United Nations estimates that this number will rise to 68% by 2050. Urban ethnobotany, the study of people’s traditional knowledge and use of plants in cities, is increasingly important as people adapt their cultural traditions to changing environments. In New York City (NYC), there have been several urban ethnobotany investigations in collaboration with Caribbean immigrant groups. However, there has yet to be an ethnobotanical survey that documents and botanically authenticates the medicinal plants used in the Haitian community. Previous collaborative research with women from the Caribbean in NYC has …

Self-Reported Audiological And Vestibular Symptoms Associated With Lyme Disease, Daniella A. Bryan

Dissertations, Theses, and Capstone Projects

Background:

Lyme disease, an infectious vector-borne illness, is carried by the deer tick, Ixodes scapularis, which harbor the spirochete, Borrelia burgdorferi, affecting hundreds of thousands of people in the United States annually. Lyme disease has a multitude of clinical presentations and overlaps with other complex illnesses, making diagnosis and treatment a medical challenge. This distinct bacterium can migrate into any organ system through the mediums of soft tissue, the lymphatic system, and the circulatory system. Despite its prevalence and range in symptomatology, minimal research has been conducted to identify distinct audiological and vestibular symptoms associated with a Lyme …