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Articles 20971 - 21000 of 24519
Full-Text Articles in Medicine and Health Sciences
Association Between The Social Vulnerability Index And Adverse Pregnancy Outcomes, Tetsuya Kawakita, Misa Hayasaka, Lindsay Robbins, Juliana Martins, George Saade
Association Between The Social Vulnerability Index And Adverse Pregnancy Outcomes, Tetsuya Kawakita, Misa Hayasaka, Lindsay Robbins, Juliana Martins, George Saade
Department of Obstetrics & Gynecology Faculty Publications
Objective: To assess the association between the Social Vulnerability Index (SVI) and racial disparities in pregnancy outcomes across U.S. counties and to quantify these racial disparities.
Methods: This was a cross-sectional study using restricted Centers for Disease Control and Prevention data sets, including natality data sets, fetal death data sets, and all-cause mortality data sets from 2016 to 2021. We limited analyses to Black or White individuals aged 15-44 years from 3,114 U.S. counties. Participants were categorized into quartiles based on county-level SVI. The primary outcome was maternal mortality rate while pregnant or within 42 days of the end of …
Microbial Remodeling Of Gut Tryptophan Metabolism And Indole-3-Lactate Production Regulate Epithelial Barrier Repair And Viral Suppression In Human And Simian Immunodeficiency Virus Infections, Clarissa Santos Rocha, Katie L. Alexander, Carolina Herrera, Mariana G. Weber, Irina Grishina, Lauren A. Hirao, Dylan J. Kramer, Juan Arredondo, Abigail Mende, Katti R. Crakes, Anne N. Fenton, Maria L. Marco, David A. Mills, John C. Kappes, Lesley E. Smythies, Paul Ziprin, Sumathi Sankaran-Walters, Phillip D. Smith, Satya Dandekar
Microbial Remodeling Of Gut Tryptophan Metabolism And Indole-3-Lactate Production Regulate Epithelial Barrier Repair And Viral Suppression In Human And Simian Immunodeficiency Virus Infections, Clarissa Santos Rocha, Katie L. Alexander, Carolina Herrera, Mariana G. Weber, Irina Grishina, Lauren A. Hirao, Dylan J. Kramer, Juan Arredondo, Abigail Mende, Katti R. Crakes, Anne N. Fenton, Maria L. Marco, David A. Mills, John C. Kappes, Lesley E. Smythies, Paul Ziprin, Sumathi Sankaran-Walters, Phillip D. Smith, Satya Dandekar
Department of Obstetrics & Gynecology Faculty Publications
Gut inflammatory diseases cause microbial dysbiosis. Human immunodeficiency virus-1 (HIV) infection disrupts intestinal integrity, subverts repair/renewal pathways, impairs mucosal immunity and propels microbial dysbiosis. However, microbial metabolic mechanisms driving repair mechanisms in virally inflamed gut are not well understood. We investigated the capability and mechanisms of gut microbes to restore epithelial barriers and mucosal immunity in virally inflamed gut by using a multipronged approach: an in vivo simian immunodeficiency virus (SIV)-infected nonhuman primate model of HIV/AIDS, ex vivo HIV-exposed human colorectal explants and primary human intestinal epithelial cells. SIV infection reprogrammed tryptophan (TRP) metabolism, increasing kynurenine catabolite levels that are …
Exposure To Phthalates And Replacements During Pregnancy In Association With Gestational Blood Pressure And Hypertensive Disorders Of Pregnancy, Erin E. Mcnell, Danielle R. Stevens, Barrett M. Welch, Emma M. Rosenthal, Suzanne Fenton, Antonia M. Calafat, Julianne Cook Botelho, Elena Sinkovskaya, Ann Przybylska, George Saade, Alfred Abuhamad, Kelly K. Ferguson
Exposure To Phthalates And Replacements During Pregnancy In Association With Gestational Blood Pressure And Hypertensive Disorders Of Pregnancy, Erin E. Mcnell, Danielle R. Stevens, Barrett M. Welch, Emma M. Rosenthal, Suzanne Fenton, Antonia M. Calafat, Julianne Cook Botelho, Elena Sinkovskaya, Ann Przybylska, George Saade, Alfred Abuhamad, Kelly K. Ferguson
Department of Obstetrics & Gynecology Faculty Publications
Exposure to endocrine-disrupting chemicals such as phthalates may increase risk of hypertensive disorders of pregnancy (HDP). Prior studies lack investigation of chemical mixtures, phthalate replacements, or key periods of susceptibility including early pregnancy. In the present study, we used a longitudinal approach to evaluate gestational exposure to phthalates and replacements, as both single-pollutants and mixtures, in association with blood pressure and diagnosis of preeclampsia or any HDP. The Human Placenta and Phthalates prospective pregnancy cohort includes 291 participants recruited from two U.S. clinics. Urinary metabolites of ten phthalates and replacements were quantified at up to 8 time points per individual …
Association Of Prenatal Exposure To Phthalates And Phenols With Adverse Pregnancy Outcomes, Misa Hayasaka, Diana Aboukhater, George Saade, Tetsuya Kawakita
Association Of Prenatal Exposure To Phthalates And Phenols With Adverse Pregnancy Outcomes, Misa Hayasaka, Diana Aboukhater, George Saade, Tetsuya Kawakita
Department of Obstetrics & Gynecology Faculty Publications
OBJECTIVE:
To evaluate the association between prenatal exposures to phthalates and phenols and adverse pregnancy outcomes, including preterm birth (PTB), small-for-gestational-age (SGA) birth weight, and gestational diabetes mellitus (GDM).
METHODS:
This study analyzed data from the Environmental Influences on Child Health Outcomes consortium, which harmonized longitudinal data on more than 30,000 pregnancies and 57,000 children from 69 cohorts across the United States and Puerto Rico. Pregnancy outcomes included PTB, SGA, and GDM, identified from medical records or self-reports. Generalized estimating equations models with Poisson distribution and robust variance were used to estimate relative risks (RRs) and 95% CIs per interquartile …
Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade
Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade
Department of Obstetrics & Gynecology Faculty Publications
OBJECTIVE:
To evaluate the association between the level of maternity care access and maternal and pregnancy-related mortality.
METHODS:
This was a cross-sectional analysis of county-level data in the United States from January 2018 to December 2021. Using the level of maternity care access, we categorized counties into desert, low access, moderate access, and full access. The primary outcome of interest was maternal mortality rate per 100,000 live births. A secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences and adjusted incidence rate ratios were calculated for maternal mortality and pregnancy-related mortality with multivariable negative binomial mixed-effects …
Methodological And Clinical Concerns In The Study On Postpartum Hypertension Management, Takaki Tanamoto, Kyosuke Kamijo, Yusuke Tsutsumi, Tetsuya Kawakita
Methodological And Clinical Concerns In The Study On Postpartum Hypertension Management, Takaki Tanamoto, Kyosuke Kamijo, Yusuke Tsutsumi, Tetsuya Kawakita
Department of Obstetrics & Gynecology Faculty Publications
[Introduction] We read with interest the recent study by Rosenfeld et al.¹ However, we have several clinical and methodological concerns about this study.¹
First, this study's propensity score matching (PSM) lacked key clinical confounders, including perinatal risk factors and the highest systolic/diastolic blood pressures. Smoking, alcohol use, and multifetal gestation, which influence blood pressure during pregnancy,²,³ potentially affect both primary and secondary outcomes. Additionally, the authors did not report standardized mean differences before and after PSM, which are essential for assessing balance.⁴
Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang
Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang
Department of Obstetrics & Gynecology Faculty Publications
Background
Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.
Methods
This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular …
Association Between The Intensity Of Exercise In The First Trimester And Early Second Trimester And The Risk Of Gestational Diabetes, Takaki Tanamoto, Misa Hayasaka, Tetsuya Kawakita
Association Between The Intensity Of Exercise In The First Trimester And Early Second Trimester And The Risk Of Gestational Diabetes, Takaki Tanamoto, Misa Hayasaka, Tetsuya Kawakita
Department of Obstetrics & Gynecology Faculty Publications
Objective
Although some studies show that exercise decreases the incidence of gestational diabetes mellitus (GDM), the optimal exercise intensity during pregnancy remains unclear. We examined GDM risk according to exercise intensity in pregnant individuals.
Methods
We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers‐to‐Be (nuMoM2b), a prospective study enrolling nulliparous individuals in the first trimester. Participants with pregestational diabetes or delivery before 20 weeks were excluded. Exercise intensity during the first (6–13 weeks’ gestation) and early second (16–21 weeks’ gestation) trimesters was categorized by metabolic equivalent of task hours per week (MET‐hr/week) as none, low intensity (< 7.5), moderate intensity (7.5–14.9), or high intensity (≥ 15). The primary outcome was GDM; secondary outcomes included preeclampsia, gestational hypertension, preterm birth, small‐for‐gestational‐age birth, and stillbirth. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) were calculated using a generalized linear mixed‐effects model with a Poisson distribution and robust error variance, controlling for the random effects of individuals and potential confounders.
Results …
Longitudinal Assessment Of Intravillous Arterioles In Normal Pregnancy Using Superb Microvascular Imaging, R. Horgan, E. Sinkovskaya, G. Saade, E. Kalafat, A. Heeze, A. Abuhamad
Longitudinal Assessment Of Intravillous Arterioles In Normal Pregnancy Using Superb Microvascular Imaging, R. Horgan, E. Sinkovskaya, G. Saade, E. Kalafat, A. Heeze, A. Abuhamad
Department of Obstetrics & Gynecology Faculty Publications
Objective
To use superb microvascular imaging (SMI) to longitudinally evaluate blood flow in intravillous arterioles (IVA) in pregnancy, and to develop reference ranges for IVA pulsatility index (PI) and peak systolic velocity (PSV) from 12 to 38 weeks' gestation.
Methods
The data for this study were obtained from the National Institutes of Health-funded Human Placenta Project. Eligible for inclusion were women aged 18-35 years, with a body mass index of < 30 kg/m², without comorbidities, with a singleton pregnancy conceived spontaneously and a gestational age of ≤ 13 + 6 weeks. Exclusion criteria were maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation and delivery < 37 weeks. Each participant underwent eight ultrasound examinations during pregnancy. Using SMI technology, the total number of IVA identified was recorded in a sagittal placental section at the level of cord insertion. The PI and PSV were measured in a total of six IVA (two in the central portion of the placenta, two peripherally towards the uterine fundal portion and two peripherally towards the lower uterine segment). Umbilical artery (UA)-PI was also obtained. Multilevel regression models were used to create reference ranges for IVA-PI and IVA-PSV at 12-38 weeks' gestation.
Results
A total of 90 women fulfilled the study criteria. IVA-PI decreased throughout pregnancy from a mean ± SD of 1.04 ± 0.23 in the first trimester (at 12-13 weeks) …
Mobile Health Intervention Tools Promoting Hiv Pre-Exposure Prophylaxis Among Adolescent Girls And Young Women In Sub-Saharan Africa: Scoping Review, Alex Emilio Fischer, Homaira Hanif, Jacob B. Stocks, Aimee E. Rochelle, Karen Dominguez, Eliana Gabriela Armora Langoni, H. Luz Mcnaughton Reyes, Gustavo F. Doncel, Kathryn E. Muessig
Mobile Health Intervention Tools Promoting Hiv Pre-Exposure Prophylaxis Among Adolescent Girls And Young Women In Sub-Saharan Africa: Scoping Review, Alex Emilio Fischer, Homaira Hanif, Jacob B. Stocks, Aimee E. Rochelle, Karen Dominguez, Eliana Gabriela Armora Langoni, H. Luz Mcnaughton Reyes, Gustavo F. Doncel, Kathryn E. Muessig
Department of Obstetrics & Gynecology Faculty Publications
Background:
In 2022, 3100 adolescent girls and young women in sub-Saharan Africa experienced new HIV infections each week. HIV pre-exposure prophylaxis (PrEP) is effective at preventing HIV but has limited uptake and persistence. Mobile health (mHealth) interventions can improve medication adherence; however, their utility to improve PrEP adherence among adolescent girls and young women is not well established.
Objective:
This scoping review synthesizes evidence supporting mHealth for PrEP among adolescent girls and young women in sub-Saharan Africa and identifies strategies for further evaluation.
Methods:
We searched PubMed and Google Scholar databases, expert referrals, and reference lists using the following eligibility …
Association Of Mean Arterial, Systolic, And Diastolic Blood Pressure Trends In Early Pregnancy With Superimposed Preeclampsia With Severe Features In Pregnancies Complicated By Chronic Hypertension, Tetsuya Kawakita, Justin M. Leach, George R. Saade, Kim Boggess, Lorraine Dugoff, Brenna L. Hughes, Joseph Bell, Kjersti Aagaard, Rodney K. Edwards, Kelly Gibson, David M. Haas, Lauren Plante, Torri Metz, Brian Casey, Sherri Longo, Matthew K. Hoffman, Kara K. Hoppe, Methodius Tuuli, Michelle Y. Owens, Heather Frey, Todd Rosen, Uma M. Reddy, Wendy Kinzler, Emily Su, Iris Krishna, Mary E. Norton, Daniel Skupski, Yasser Y. El-Sayed, Ronald Librizzi, Mounira Habli, Shauna Williams, Gabriella Pridjian, David S. Mckenna, Sarah Osmundson, Joanne Quinones, Zorina Galis, Lorie Harper, Namasivayam Ambalavanan, Jeff M. Szychowski, Alan T.N. Tita
Association Of Mean Arterial, Systolic, And Diastolic Blood Pressure Trends In Early Pregnancy With Superimposed Preeclampsia With Severe Features In Pregnancies Complicated By Chronic Hypertension, Tetsuya Kawakita, Justin M. Leach, George R. Saade, Kim Boggess, Lorraine Dugoff, Brenna L. Hughes, Joseph Bell, Kjersti Aagaard, Rodney K. Edwards, Kelly Gibson, David M. Haas, Lauren Plante, Torri Metz, Brian Casey, Sherri Longo, Matthew K. Hoffman, Kara K. Hoppe, Methodius Tuuli, Michelle Y. Owens, Heather Frey, Todd Rosen, Uma M. Reddy, Wendy Kinzler, Emily Su, Iris Krishna, Mary E. Norton, Daniel Skupski, Yasser Y. El-Sayed, Ronald Librizzi, Mounira Habli, Shauna Williams, Gabriella Pridjian, David S. Mckenna, Sarah Osmundson, Joanne Quinones, Zorina Galis, Lorie Harper, Namasivayam Ambalavanan, Jeff M. Szychowski, Alan T.N. Tita
Department of Obstetrics & Gynecology Faculty Publications
OBJECTIVE: To evaluate the association of longitudinal systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in early pregnancy with later development of superimposed preeclampsia with severe features in pregnancies complicated by mild chronic hypertension.
METHODS: This secondary analysis used data from the CHAP (Chronic Hypertension and Pregnancy) trial, a multicenter randomized controlled trial that involved pregnant individuals with chronic hypertension. Participants were categorized based on the development of superimposed preeclampsia with severe features. Longitudinal blood pressure measurements from enrollment to the development of superimposed preeclampsia with severe features or delivery were assessed using regression models. …
Racial Disparities In Maternal Mortality Before, During, And After The Covid-19 Pandemic In The United States: A Difference-In-Difference Analysis, Kyosuke Kamijo, Misa Hayasaka, Tetsuya Kawakita
Racial Disparities In Maternal Mortality Before, During, And After The Covid-19 Pandemic In The United States: A Difference-In-Difference Analysis, Kyosuke Kamijo, Misa Hayasaka, Tetsuya Kawakita
Department of Obstetrics & Gynecology Faculty Publications
Background
This study aimed to examine changes in racial disparities in pregnancy-related and maternal mortality before, during, and after the COVID-19 pandemic in the United States.
Methodology
This was a cross-sectional study using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data from January 2018 to June 2024. We focused on pregnancy-related and maternal mortality among Black and White individuals to examine racial disparities. The study periods were defined as pre-pandemic (January 2018-March 2020), pandemic (April 2020-March 2022), and post-pandemic (April 2022-June 2024). We applied interrupted time series analysis and difference-in-difference (DID) models …
Longitudinal Assessment Of Fetal Myocardial Performance Index In Normal Pregnancy Using Spectral Tissue Doppler, R. Horgan, E. Sinkovskaya, E. Kalafat, G. Saade, A. Abuhamad
Longitudinal Assessment Of Fetal Myocardial Performance Index In Normal Pregnancy Using Spectral Tissue Doppler, R. Horgan, E. Sinkovskaya, E. Kalafat, G. Saade, A. Abuhamad
Department of Obstetrics & Gynecology Faculty Publications
Objective
Although spectral tissue Doppler imaging is recognized as the optimal method for assessing the fetal myocardial performance index (MPI), longitudinal reference ranges for fetal MPI measured using spectral tissue Doppler have not been established. Our objective was to use spectral tissue Doppler data to establish gestational-age-specific reference ranges from 12–33 weeks for left and right ventricular fetal MPI.
Methods
This was a prospective longitudinal study of women aged 18–35 years, with a body mass index below 30 kg/m² and a singleton pregnancy conceived spontaneously. Fetal MPI measurements were obtained in the first, second and third trimesters and MPI was …
American Heart Association Blood Pressure Classification And Subsequent Risk Of Preeclampsia, Rebecca Horgan, Erkan Kalafat, Elena Sinkovskaya, Alfred Abuhamad, George Saade
American Heart Association Blood Pressure Classification And Subsequent Risk Of Preeclampsia, Rebecca Horgan, Erkan Kalafat, Elena Sinkovskaya, Alfred Abuhamad, George Saade
Department of Obstetrics & Gynecology Faculty Publications
Background: In 2017, the American Heart Association (AHA) and American College of Cardiology updated their hypertension guidelines for the nonpregnant population, lowering the diagnostic thresholds to systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg. This reclassification has raised important questions regarding whether blood pressure (BP) values previously considered within the normal range in pregnancy may, in fact, confer an increased risk for hypertensive disorders of pregnancy (HDPs).
Objective: To evaluate the association between first-trimester BP classified by AHA thresholds and the subsequent development of HDPs.
Study design: This was a secondary analysis of a prospective, multicenter cohort …
Timing Of Delivery In Preeclampsia: Time To Reconsider?, Rebecca Horgan, Ahmed S. Z. Moustafa, Mackenzie Mchugh, Tetsuya Kawakita, Baha Sibai, George Saade
Timing Of Delivery In Preeclampsia: Time To Reconsider?, Rebecca Horgan, Ahmed S. Z. Moustafa, Mackenzie Mchugh, Tetsuya Kawakita, Baha Sibai, George Saade
Department of Obstetrics & Gynecology Faculty Publications
The article discusses the need to reassess the timing of delivery in cases of preeclampsia, a condition affecting 2%–8% of pregnancies and linked to significant maternal and neonatal risks. It highlights that existing guidelines, primarily based on older studies, may not adequately reflect current clinical practices and advancements in neonatal care. The authors suggest that planned delivery at 34–36 weeks of gestation may offer maternal benefits without increasing short-term neonatal morbidity, while also emphasizing the importance of considering long-term outcomes for both mothers and infants. They advocate for further research, including large-scale randomized trials, to better understand the implications of …
A Rare Complication Of Dilation And Evacuation: Unrecognized Extrauterine Retained Products Of Conception, Aviana Terschueren, Lauren Siewertsz Van Reesema, Joseph Hudgens
A Rare Complication Of Dilation And Evacuation: Unrecognized Extrauterine Retained Products Of Conception, Aviana Terschueren, Lauren Siewertsz Van Reesema, Joseph Hudgens
Department of Obstetrics & Gynecology Faculty Publications
Introduction: Surgical abortions, including dilation and evacuation, are among the safest gynecological procedures, with complication rates ranging from 0.5–4.0%. Uterine perforation, though rare (0.2–0.8%), can result in serious sequela, including translocation of retained products of conception into the abdominal cavity. We present a rare case of abdominal retained products of conception following a second-trimester dilation and evacuation.
Case Report: A 29-year-old G3P1112 underwent an elective surgical abortion at 17 weeks’ gestation, complicated by hemorrhage necessitating transfer to an outside hospital. She was treated with uterotonics and a blood transfusion and was discharged after a 6-day hospitalization. Initial transvaginal ultrasound showed …
Association Between Adverse Pregnancy Outcomes And Awareness Of Cardiovascular Risk Factors: A Numom2b-Hhs Secondary Analysis, Elizabeth M. Wendl, Amanda A. Allshouse, Ashley Goodwin, Bri Hobbs, Philip Greenland, Lisa Levine, William Grobman, George R. Saade, Natalie Cameron, C. Noel Bairey Merz, Caroline Rouse, Sarah Rogan, Judith H. Chung, Lauren H. Theilen, National Heart, Lung, And Blood Institute Numom2b Heart Health Study Network
Association Between Adverse Pregnancy Outcomes And Awareness Of Cardiovascular Risk Factors: A Numom2b-Hhs Secondary Analysis, Elizabeth M. Wendl, Amanda A. Allshouse, Ashley Goodwin, Bri Hobbs, Philip Greenland, Lisa Levine, William Grobman, George R. Saade, Natalie Cameron, C. Noel Bairey Merz, Caroline Rouse, Sarah Rogan, Judith H. Chung, Lauren H. Theilen, National Heart, Lung, And Blood Institute Numom2b Heart Health Study Network
Department of Obstetrics & Gynecology Faculty Publications
Background
Adverse pregnancy outcomes (APOs) affect 10%-20% of pregnancies and are associated with increased risk of cardiovascular disease.
Objective
To determine whether the history of APO is associated with a person's awareness of their cardiovascular risk factors (CRF) 2-7 years postpartum.
Methods
This is a secondary analysis of a multicenter cohort study in which nulliparous pregnant people were enrolled in the first trimester and followed prospectively. Participants with a CRF (hypertension, dyslipidemia, and/or prediabetes/diabetes) at follow-up were included. We excluded participants with: pre-gestational diabetes, chronic hypertension, dyslipidemia during the index pregnancy or subsequent pregnancy, and non-fasting blood draws. The exposure …
Maternal Mortality According To State Abortion Legislative Climate Following The Us Supreme Court's Dobbs V. Jackson Women's Health Organization Ruling, Emily Nuss, Mari Iwasaki, Lindsay Robbins, Peggy Ye, Misa Hayasaka, George Saade, Tetsuya Kawakita
Maternal Mortality According To State Abortion Legislative Climate Following The Us Supreme Court's Dobbs V. Jackson Women's Health Organization Ruling, Emily Nuss, Mari Iwasaki, Lindsay Robbins, Peggy Ye, Misa Hayasaka, George Saade, Tetsuya Kawakita
Department of Obstetrics & Gynecology Faculty Publications
Objective
We aimed to evaluate how maternal mortality rates have evolved across US states following the Dobbs ruling, while accounting for the confounding influence of the coronavirus disease 2019 (COVID-19) pandemic.
Study Design
We conducted a retrospective analysis of publicly available data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database from January 2018 to December 2024. This study period was divided into three intervals: (1) pre-COVID (January 2018 to February 2020), (2) pandemic (March 2020 to September 2022), and (3) post-Dobbs (October 2022 to December 2024). Using the Kaiser Family Foundation …
Online Learning-Driven Human Intent Estimation And Control For Human-Robot Interaction, Irfan Ganie, S. Jagannathan
Online Learning-Driven Human Intent Estimation And Control For Human-Robot Interaction, Irfan Ganie, S. Jagannathan
Electrical and Computer Engineering Faculty Research & Creative Works
This paper presents a novel Stackelberg-game theoretic multilayer-online learning framework for cooperative control of nonlinear Physical Human-Robot Interaction (pHRI), where the human is modeled as the leader guiding a robot follower. This hierarchical interaction is captured as a dynamic Stackelberg game, with the human's intention estimated in real-time through online multilayer neural networks (MNNs). We introduce SVD-based weight update laws for actor-critic MNNs, which approximate value functions and control inputs for both human and robot, eliminating the need for predefined basis functions. In this framework, the human objective is first inferred and used to guide the robot actions by shaping …
Improved Optimal Tracking Of Uncertain Nonlinear Discrete-Time Systems Using Experience Replay, Maxwell Geiger, Sarangapani Jagannathan
Improved Optimal Tracking Of Uncertain Nonlinear Discrete-Time Systems Using Experience Replay, Maxwell Geiger, Sarangapani Jagannathan
Electrical and Computer Engineering Faculty Research & Creative Works
This paper addresses the infinite horizon optimal tracking control problem for partially uncertain control-affine nonlinear discrete-time (DT) systems, where the control input dynamics are known. Multi-layer critic and actor neural networks (MNNs) are utilized for online estimation of the infinite horizon value function and optimal control input. The NN weights are tuned online using a direct temporal difference error (TDE)-driven learning approach, which modifies the singular values of the gradient with respect to the NN weights to accelerate their convergence. The critic NN uses a novel experience replay technique to improve sample efficiency without introducing biased TDEs and guarantee the …
Multi-Model Safe Neuro-Optimal Output Tracking Control Of Autonomous Surface Vessels With Explainable Ai, Behzad Farzanegan, S. Jagannathan
Multi-Model Safe Neuro-Optimal Output Tracking Control Of Autonomous Surface Vessels With Explainable Ai, Behzad Farzanegan, S. Jagannathan
Electrical and Computer Engineering Faculty Research & Creative Works
This paper presents a safety-aware deep reinforcement learning (DRL)-based trajectory tracking control of autonomous surface vessels (ASVs). A multilayer neural network (MNN) observer estimates the ASV's state and uncertain dynamics. By utilizing the estimate state vector from the observer, a safety-aware DRL-based optimal policy is formulated using control barrier function (CBF) and Karush-Kuhn-Tucker (KKT) conditions. An actor-critic MNN with singular value decomposition (SVD)-based update mitigates vanishing gradients. To enhance adaptability, an online safe lifelong learning (SLL) scheme counters catastrophic forgetting across varying ASV dynamics. The Shapley Additive Explanations (SHAP) method identifies key features influencing the control policy. Simulations on an …
Reinforcement Learning-Based Nonlinear Optimal Discrete-Time Control Of Power Systems, Vijay Kumar Singh, Behzad Farzanegan, S. Jagannathan
Reinforcement Learning-Based Nonlinear Optimal Discrete-Time Control Of Power Systems, Vijay Kumar Singh, Behzad Farzanegan, S. Jagannathan
Electrical and Computer Engineering Faculty Research & Creative Works
This paper presents a partially model-free adaptive optimal tracking control method for power systems, specifically targeting a synchronous generator connected through a reactive transmission line. By integrating the tracking error dynamics with reference trajectory dynamics, an augmented system is created. A discounted performance function is introduced to address the nonlinear tracking problem optimally. Unlike traditional methods that compute feedforward and feedback terms separately, the proposed approach calculates both simultaneously by minimizing the discounted performance function. The discrete-time tracking Bellman and Hamilton-Jacobi-Bellman (HJB) equations are derived, and a reinforcement learning (RL)-based technique is employed to solve the optimal policy online without …
Enhanced Continual Reinforcement Learning-Based Output Feedback Control Of Heterogeneous Quadrotors Formation, Ehsan Soleimani, S. Jagannathan
Enhanced Continual Reinforcement Learning-Based Output Feedback Control Of Heterogeneous Quadrotors Formation, Ehsan Soleimani, S. Jagannathan
Electrical and Computer Engineering Faculty Research & Creative Works
This paper presents a unified framework for the safe and optimal control of heterogeneous quadrotor unmanned aerial vehicles (QUAVs) in formation, enabling multitask missions without requiring precise system dynamics. To address partial state observability, a multilayer neural network (MNN) observer is designed to estimate unmeasured states. Reinforcement learning (RL) is employed for optimal control utilizing an MNN ensuring adaptability. Barrier Lyapunov Functions (BLFs) are integrated into the RL framework to enforce safety by maintaining QUAVs within predefined constraints. An enhanced continual learning (ECL) method is proposed to improve the adaptability of MNNs. This method enables effective multitask learning while mitigating …
Evaluating Nurse Conscientious Objection: Application Of A Novel Framework, Maya Zumstein-Shaha, Lucia D. Wocial, Vicki D. Lachman, Norah Louise Johnson, Cynda Hylton Rushton, Pamela J. Grace
Evaluating Nurse Conscientious Objection: Application Of A Novel Framework, Maya Zumstein-Shaha, Lucia D. Wocial, Vicki D. Lachman, Norah Louise Johnson, Cynda Hylton Rushton, Pamela J. Grace
College of Nursing Faculty Research and Publications
Certain moral beliefs and/or values about what is good or harmful can cause nurses and other healthcare professionals to object to participating in some clinical actions. Such objections are also called conscientious objections. Invocation of a conscientious objection (CO) can produce complexities in patient care and health care delivery and must be mindfully evaluated for its soundness. In this manuscript, a recently developed framework, The Ethical Evaluation of a Nurse’s Conscientious Objection (EENCO), is applied to expose hidden elements and nuances in a proposed or actual CO by nurses or other healthcare professionals, thereby illuminating strategies that can lessen associated …
Reversible Degradation Of Peptidoglycan By Lytic Transglycosylases, Aaron Devereaux
Reversible Degradation Of Peptidoglycan By Lytic Transglycosylases, Aaron Devereaux
Theses and Dissertations (Comprehensive)
Antimicrobial resistance continues to be a burden on the global healthcare system with an estimated cost of billions of dollars and millions of deaths each year. Recently, there has been little to no development on new antibiotics to treat bacterial infection, and any that are developed become resisted to within a few years. Both Gram-positive and Gram-negative bacteria contain a mesh-like layer called peptidoglycan (PG) that surrounds their cells providing strength, cell shape, and protection from their environments. This layer is a polymer of N-acetylmuramic acid (MurNAc) and N-acetylglucosamine (GlcNAc) connected via a b-1,4-glycosidic bond, with each strand being cross-linked …
A Word From The Writing Team (January 2025), Pam Walter, Mfa, Hemma Murali, Ms
A Word From The Writing Team (January 2025), Pam Walter, Mfa, Hemma Murali, Ms
A Word From the Writing Team (Newsletter)
This issue includes:
- New Year and a New Consultant at the OPWPC
- Publication Spotlight
- Attend First Friday Writing Retreats (Online)
- Workshop Series: Write that Baby in 9 Weeks
- Waived fees for open access publishing!
- The OPWPC Canvas Page offers helpful tools
Ambulatory Arterial Stiffness Index: Regression Method Comparison And Its Association With Pulse Pressure And Circadian Patterns, José R. Ayala-Hernández, Cristina López-Sánchez, Orlando M. Ayala, Camilo E. Palencia-Tejedor
Ambulatory Arterial Stiffness Index: Regression Method Comparison And Its Association With Pulse Pressure And Circadian Patterns, José R. Ayala-Hernández, Cristina López-Sánchez, Orlando M. Ayala, Camilo E. Palencia-Tejedor
Engineering Technology Faculty Publications
The Arterial Stiffness Index (AASI) is a calculation obtained through Ambulatory Blood Pressure Monitoring (ABPM), and is an indirect measure of the elastic properties of the arterial wall; but there is heterogeneity in its scope as a predictor of vascular wall health. A comparison is made between linear regression and exponential regression of the AASI, as well as an analysis of variance, according to circadian patterns and pulse pressure (PP) values. This work is an analytical observational study in 106 individuals, most of them women (63%) with a mean age of 53 ± 17.32 years. The coefficient of determination (r2) …
Procedural Skills Gaps And Ultrasound Training In Saudi Medical Interns: A Cross-Sectional Survey, Rajkumar Rajendram, Abdullah Abdulrahman Alshamrani, Waleed Khalid Jarwan, Afnan Ali Alghamdi, Arif Hussain
Procedural Skills Gaps And Ultrasound Training In Saudi Medical Interns: A Cross-Sectional Survey, Rajkumar Rajendram, Abdullah Abdulrahman Alshamrani, Waleed Khalid Jarwan, Afnan Ali Alghamdi, Arif Hussain
Health Professions Education
Purpose: Medical internships lay the foundation for physicians' careers. While the scope of medical practice has broadened, the emphasis on procedural skills remains crucial. However, concerns persist regarding the adequacy of current internship training programs, particularly in the context of the increasing importance of ultrasound-guided procedures (UGPs). This study aims to assess the perceived relevance of procedural skills training and identify skill gaps among medical interns at our institution.
Aim: To assess medical interns' perceptions of the relevance of procedural skills training, with a specific focus on ultrasound guidance and to identify skill gaps within the internship program at our …
Breaking Down Silos: Creating And Implementing A Longitudinal Interprofessional Education Curriculum For Graduate Health Science Professional Students, Robert Wellmon, Jill D. Black, Wendy Wachter-Schutz, Kathleen M. Youse, Adrienne N. Pinckney, Lori L. Felker
Breaking Down Silos: Creating And Implementing A Longitudinal Interprofessional Education Curriculum For Graduate Health Science Professional Students, Robert Wellmon, Jill D. Black, Wendy Wachter-Schutz, Kathleen M. Youse, Adrienne N. Pinckney, Lori L. Felker
Health Professions Education
Background. Accreditation standards for graduate health professional programs require the inclusion of interprofessional learning and collaboration (IPL/C) activities in entry-level curricula. This implementation necessitates collaboration among educators from multiple disciplines and openness to innovation and to educate students in a manner that breaks down uni-professional curriculum silos that are known barriers to the creation of meaningful IPL experiences.
Objective. The purpose of this paper is to describe one institution’s process for creating a longitudinal interprofessional education (IPE) curriculum that aligns with accreditation mandates and meets the call to foster IPC competency skills.
Methods. Widener University established an interprofessional thread of …
The Remote Supervision Road To Registrar Training In Australia - Paving The Path With Pixels And Phones (A Narrative Review)., Nicholas Coburn, Kylie Fitzgerald, Brett Vaughan
The Remote Supervision Road To Registrar Training In Australia - Paving The Path With Pixels And Phones (A Narrative Review)., Nicholas Coburn, Kylie Fitzgerald, Brett Vaughan
Health Professions Education
Purpose: Specialist medical training in rural or remote Australia is limited due to current requirements of specialist medical colleges to supervise and train registrars onsite. Remote supervision, where the registrar is supervised via telephone and videoconferencing technology remotely, offers a solution that allows doctors to train in rural or remote areas. This review describes the opportunities, challenges, and recommendations to pave the path for a best practice model of remote supervision for private practice focused registrar training in Australia which may offer insights for other countries with rural and remote medical workforces.
Methods: Ovid Medline and Ovid Embase were …