Medicine and Health Sciences Commons^™

Single-Cell Expression Analysis Of Ductal Carcinoma In Situ Identifies Complex Genotypic-Phenotypic Relationships Altering Epithelial Composition, Xiaodi Qin, Xiaoke Luo, Graham A Colditz, Shu Jiang, Et Al.

2020-Current year OA Pubs

UNLABELLED: Ductal carcinoma in situ (DCIS) is a risk factor for subsequent invasive breast cancer (IBC). To identify events in DCIS that lead to invasive cancer, we performed single-cell RNA sequencing on DCIS lesions and matched normal breast tissue. Inferred copy-number variation was used to identify neoplastic epithelial cells from clinical specimens, which contained a mixture of DCIS and normal ducts. Phylogenetic analysis demonstrated intratumoral clonal heterogeneity that was associated with significant gene expression differences. Classification of epithelial cells into mammary cell states revealed that subclones contained a mixture of cell states, suggesting an ongoing pattern of differentiation after neoplastic …

Early Results With Embotrap Iii Stent Retriever: A Multicenter Us Experience, Georgios S Sioutas, Alex N Hoang, Fadi Al Saiegh, Oz Haim, Sanjana Salwi, Avi A Gajjar, Mohamed M Salem, Peter Kan, Omar Tanweer, Justin R Mascitelli, Brian T Jankowitz, Jan-Karl Burkhardt, Visish M Srinivasan

Faculty, Staff and Students Publications

Background

Mechanical thrombectomy with stent retrievers has become a standard treatment for acute ischemic stroke due to large vessel occlusion. Here we present a multicenter US experience using the EmboTrap III stent retriever, the latest iteration within its class.

Methods

We retrospectively reviewed patients with acute ischemic stroke treated with the EmboTrap III device at 4 US centers. We recorded baseline demographics, clinical characteristics, and procedural details. Outcomes included first-pass effect (FPE), modified FPE (mFPE), final mTICI scores, 90-day functional outcomes, and complications.

Results

A total of 92 patients were included, median age of 72 years, and 56.5% were women. …

Short-Term Outcomes Of A Comprehensive Rehabiliation Program With Peripheral Magnetic Stimulation In Polyneuropathy: A Case Report, Tuangtip Surarangsit

Chulalongkorn Medical Journal

Polyneuropathy, a condition affecting the peripheral nervous system, often results in sensory and motor dysfunction in older adults. Treatment options include medications and various physical therapy modalities including Peripheral Magnetic Stimulation (PMS). However, evidence supported treating nerve dysfunction with PMS is limited. In this case, an 84-year-old male with a history of diabetes mellitus and osteoarthritis presented with bilateral lower extremity sensory and motor polyneuropathy, experiencing weakness, sensory deficits, and gait instability. After limited success with conventional treatments, a comprehensive rehabilitation program was implemented over four weeks, integrating PMS, occupational therapy, and advanced gait training. Following the intervention, light touch …

A Tubo-Ovarian Abscess In Aplastic Anemia Presenting As Fever Of Unknown Origin, Rashi Mittal, Saurabh Kumar Gautam, Prasan Kumar Panda, Latika Chawla

Chulalongkorn Medical Journal

This report describes a complex case of a tubo-ovarian abscess (TOA) presenting atypically as fever of unknown origin (FUO) in a young woman initially diagnosed with severe aplastic anemia. The case involved protracted febrile illness, heavy menstrual bleeding, and pancytopenia. Identification of an Escherichia coli tubo-ovarian abscess, rather than tuberculosis, emphasized the need for a thorough evaluation in atypical presentations of TOA. Negative tuberculosis tests highlighted the variety of possible microbial etiologies. The resolution of fever following drainage and tailored antibiotic therapy, along with timely surgical intervention, demonstrated the importance of specific management strategies in such cases. Awareness of the …

Combined Anterior Palatoplasty With Barbed Suspension Pharyngoplasty In The Treatment Of Obstructive Sleep Apnea, Patheemon Thanachaikun, Natamon Charakorn

Chulalongkorn Medical Journal

Background: Surgery is a treatment option for obstructive sleep apnea (OSA) patients for whom positive airway pressure therapy is not chosen. Various palatal surgical techniques have been developed. However, the medical literature has limited accounts concerning the use of combination of these techniques to improved outcomes.

Objective: The aim of this study is to assess the efficacy of a combined anterior palatoplasty (AP) and barbed suspension pharyngoplasty (BSP) in treating adult OSA.

Methods: Data of OSA patients who underwent the combined AP with BSP between July 2020 to May 2024 were retrospectively reviewed. The surgical outcomes, including apnea-hypopnea index (AHI), …

The Factors Affecting The Distribution Of Scorpions (Arachnida: Scorpions) In Iran, Hassan Nasirian

Chulalongkorn Medical Journal

Background: The distribution of scorpions is influenced by various factors that determine their presence and abundance in different regions. Understanding these factors is crucial for comprehending scorpion ecology and predicting their potential impact on ecosystems. Objective: These subtopics aim to provide an overview of the distribution of scorpions within Iran and the factors affecting their distribution, highlighting their ecological preferences and adaptations to different regions.

Methods: Forty-nine documents were collected from well-known indexing services, including Elsevier, Google Scholar, PubMed, ScienceDirect, Scopus, Springer, and Web of Science. After carefully studying the documents, they were classified into specific topics and discussed.

Results: …

Job Strain And Associated Factors Among Medical School Employees In Thailand: A Cross-Sectional Study, Jakarin Apisuttisin, Pornchai Sithisarankul, Jate Ratanachina

Chulalongkorn Medical Journal

Introduction: Mental health issues are rising among workers, often linked to job strain. Medical schools, with their diverse workforce including not only healthcare workers and educators but also support staff, are in demanding work environments and are susceptible to job strain. This study aimed to investigate the prevalence and associated factors of job strain among support staff at a medical school in Bangkok, Thailand.

Methods: A cross-sectional study of 721 support staff employed at a medical school in Bangkok, Thailand was conducted between May and July 2024. The questionnaire consisted of three sections including demographic data, work-related factors, and the …

Clinical Factors Predicting The Need For Biopsy In Children With Cervical Lymphadenopathy, Pornchai Achatsachat, Nimmita Srisan, Prapapan Rajatapiti, Katawaetee Decharun, Somboon Reukvibunsi, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Background: Lymphadenopathy in children is often a diagnostic challenge for clinicians. It may be one symptom of many diseases including granulomatous diseases and malignancy. The cervical region is a commonly involved area in peripheral lymphadenopathy. Surgical biopsy often provides a definitive diagnosis but occasionally unnecessary in some cases.

Objectives: The objective was to describe children with cervical lymphadenopathy who underwent surgical biopsies and to determine clinical factors that can predict the likelihood of lymph nodes needing further management (LNFM) including granulomatous and malignant lymph nodes. Methods: Data of 87 children with cervical lymphadenopathy undergoing surgical biopsy were retrospectively reviewed. Descriptive …

Analysis Of Personality Traits, Intelligence Level And Ability To Cope With Stressful Situations And Their Impact On The Evaluation Of Judo Fights, Maciej Kostrzewa, Jan Supinski, Slawomir Kownacki, Miłosz Drozd, Anna Ścisłowska-Czarnecka, Jarosław Markowski, Jan Pilch, Alicja Markiel, Marcin Żak, Adam Maszczyk

Baltic Journal of Health and Physical Activity

Background: The aim of the study presented in this article was to conduct an analysis that would answer the research question: do personality traits such as extraversion, neuroticism, openness to experience, agreeableness, conscientiousness, intelligence level, and ability to cope with stressful situations correlate with the assessment of judo fights? Materials and Methods: Ninety individuals participated in the study, including international-class referees, national-class referees, coaches, and active judo athletes. The study used a correlational analysis approach to examine the relationships between personality traits and fight assessment criteria in judo. Results: The results indicate that in the referees' group, there is a …

The Impact Of Type 2 Diabetes Mellitus On The Severity Of Alzheimer's Disease In Hispanic Populations In The Rio Grande Valley: A Pilot Retrospective Chart Review, Maria Camila Gonzalez Tovar, Daniel Salinas, Kelsey Baker

School of Medicine Publications

Background: Alzheimer's disease (AD) is becoming more prevalent worldwide, leading to a growing demand to understand the impact of risk factors on disease progression. Notably, type 2 diabetes mellitus (DM) has emerged as a significant risk factor for the development of AD, given the pathophysiological role of insulin resistance in cognitive impairment. In particular, the impact of type 2 DM on AD development and severity may be heightened in Hispanic populations due to the high prevalence of both conditions in this community. Here, we sought to understand the role of type 2 DM in AD severity in a Hispanic population …

Molecular Mechanisms Of L-Type Calcium Channel Dysregulation In Heart Failure, Arbab Khalid, Abu-Bakr Ahmed, Randeep Gill, Taha Shaikh, Joshua Khorsandi, Ali Kia

Department of Internal Medicine Faculty Research

The L-type calcium channels (LTCCs) function as the main entry points that convert myocyte membrane depolarization into calcium transients, which drive every heartbeat. There is increasing evidence to show that maladaptive remodeling of these channels is the cause of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Recent experimental, translational, and clinical studies have improved our understanding of the roles LTCC expression, micro-domain trafficking, and post-translational control have in disrupting excitation–contraction coupling, provoking arrhythmias, and shaping phenotype specific hemodynamic compromise. We performed a systematic search of the PubMed and Google Scholar databases (2015–2025, …

How Do Montessori-Based Activities Affect Behaviors For Older People With Dementia: A Literature Review, Isabel Quigley

University Honors Theses

Objectives: This literature review is meant to analyze the development on the research on Montessori-based activities for adults with dementia.

Introduction: Baby Boomers are the largest generation to enter senior age (65+) in history due to the advancement in medicine to increase life expectancy. Dementia is a neurocognitive disease that affects parts of the brain related to memory and signs typically surface around 65 years old. Dementia is not considered healthy aging. Montessori-based activities have been recently developed as an intervention to encourage a feeling of accomplishment and success for adults with dementia.

Methods: Two electronic databases …

The Potential For Improv As A Therapeutic Tool In The Context Of Dialectical Behavior Therapy: Suggestions For Dbt Clinicians, Jocelyn Borden

University Honors Theses

This thesis explores the theoretical and practical intersections between improvisational theater and Dialectical Behavior Therapy (DBT), proposing that the core tenets of improv closely align with the philosophical foundation and therapeutic goals of DBT. Aimed at mental health professionals, this work provides a conceptual framework and praxis for incorporating improv-based activities into DBT skills training to enhance client engagement, experiential learning, and emotional resilience. Through an examination of improv theory, parallels with DBT principles, and practical suggestions for integration, the thesis outlines how applied improvisation can be used as a supplemental tool in traditional DBT treatment. The final section includes …

Management And Optimization Of Chronic Renal Insufficiency In The Setting Of Kidney Cancer A Systematic Review, Jessica K. Cobb, Hiroko Miyagi, Jad Chahoud, Claude Bassil, Philippe E. Spiess

Division of Internal Medicine Faculty Papers & Presentations

PURPOSE: There is a bidirectional relationship between chronic kidney disease and the incidence of renal cell carcinoma. Despite the frequency of patients with both chronic kidney disease and renal cell carcinoma, there are limited systematic reviews detailing the nuanced treatment. This review provides comprehensive insights for clinicians for managing chronic kidney disease, and renal cell carcinoma. Methods and Methods: We reviewed published literature that examined either chronic kidney disease and renal cell carcinoma or an indirect contributor of both.

RESULTS: We compare and contrast renal cell carcinoma treatment with partial and radical nephrectomies, ablative techniques, and radiation and their impact …

Virtual Versus In-Person Rose Program (La Luz) As Universal Prevention For Perinatal Depression: Protocol For A Randomized Controlled Trial In A Safety Net Hospital, Daphne Y. Liu, Nicholas S. Perry, Catherine H. Demers, Jennifer S. Hyer, Anely Alamo, Paige Vuksanovich, Nandi Dube, Erin R. Flanagan, Robert J. Gallop, Galena K. Rhoades, Elysia Poggi Davis

Psychology: Faculty Scholarship

Perinatal depression disproportionally affects underserved communities, who need effective and accessible prevention programs. Reach Out, Stay strong, Essentials for new mothers (ROSE) has demonstrated effectiveness in preventing postpartum depression in underserved populations when delivered in person. This ongoing randomized controlled trial (RCT) tests the novel virtual implementation of ROSE as universal prevention in a Federally Qualified Health Center setting. We adopted the name, La Luz, for ROSE to be culturally relevant to our population. Pregnant individuals < 30 gestational weeks (target N = 900) are randomized to either the virtual or in-person La Luz program, which consists of four 90-min group sessions. Groups are offered in English and Spanish, based on participants' preference. Participants complete surveys at seven timepoints: before program, 28 gestational weeks, 35 gestational weeks, and 6-weeks, 3-months, 6-months, and 12-months postpartum. Primary outcomes are postpartum depression severity measured by the 20-item Symptom Checklist (SCL-20) and 10-item Center of Epidemiologic Studies Depression Scale (CESD-10). We will perform intent-to-treat analysis to test whether virtual La Luz is non-inferior to in-person La Luz. This study also evaluates implementation process and outcomes of both modalities of La Luz to inform the development of an implementation toolkit. This RCT contributes to our knowledge of perinatal depression prevention and addresses access barriers for underserved populations. If effectiveness of virtual La Luz is demonstrated, the new evidence for a scalable low-cost prevention can be used to reduce perinatal depression and offer accessible treatment options for people who face significant barriers to care.

Asymmetric Cingulum Bundle Connectivity Is Modulated By Paracingulate Sulcus Morphology, Isabel A Danstrom, Joshua A Adkinson, Meghan E Robinson, Lu Lin, Atul Maheshwari, Ben Shofty, Garrett Banks, Mohammed Hasen, Sameer A Sheth, Alica M Goldman, Eleonora Bartoli, Sarah R Heilbronner, Kelly R Bijanki

Faculty, Staff and Students Publications

The cingulum bundle (CB) is a group of axons supporting connectivity among several functional brain networks relevant in healthy and diseased states. The paracingulate sulcus (PCS) is present in at least one cerebral hemisphere across 70% of the population. PCS presence versus absence is linked to differences in structure and function of the anterior cingulate cortex, though the influence of PCS on the white matter of the CB remains unknown. The objective of this work was to define the CB electrographic connectivity profile and determine the impact of PCS morphology on CB engagement. Single-pulse electrical stimulation in combination with stereo-electroencephalography …

Biology Open 2024 – A Year In Review, Daniel A Gorelick

Faculty, Staff and Students Publications

No abstract provided.

Advancing Novel Contrast Agents For Applications In Fluorescence-Guided Neurosurgery Using Fluorescence Cryotomography, Augustino Vittorio Scorzo

Dartmouth College Ph.D Dissertations

Fluorescence guided surgery (FGS) is an emerging surgical technique that aims to help surgeons identify tissue types to assist in surgical decision making - ideally providing “cut-by-color” guidance. A primary application for this approach is the identification of tumor tissue to achieve more accurate and complete tumor removal while simultaneously minimizing damage to surrounding normal tissue. The cornerstone of tumor visualization for FGS is the administration of fluorescent contrast agents, or in some cases metabolic precursors, designed to accumulate specifically in tumor tissue, and a wide range of agents that use different targeting mechanisms are currently under investigation. Although these …

Type I Interferon Protects Against Bone Loss In Periodontitis By Mitigating An Interleukin (Il)-17-Neutrophil Axis, Jinmei Zhang, Qiong Ding, Angela X Wang, Maoxuan Lin, Ning Yu, Kevin Moss, Megumi A Williamson, Di Miao, Julie T Marchesan, Erliang Zeng, Wei Shi, Hongli Sun, Yu Leo Lei, Shaoping Zhang

Faculty, Staff and Student Publications

Type I interferons (IFNs-I), a group of pleiotropic cytokines, critically modulate host response in various inflammatory diseases. However, the role of the IFN-I pathway in periodontitis remains largely unknown. In this report, we describe that the IFN-β levels in the gingival crevicular fluid of human subjects were negatively associated with periodontitis and clinical gingival inflammation. Disruption of IFN-I signaling worsened alveolar bone resorption in a ligature-induced periodontitis murine model. Deficiency of the IFN-I pathway resulted in an exaggerated inflammatory response in myeloid cells and drastically increased the interleukin-17 (IL-17)-mediated neutrophil recruitment in the gingiva. We further identified that the myeloid …

Hydropneumopericardium Due To Esophageal-Pericardial Fistula: A Rare Complication Of Esophageal Stenting, Svenja Schneider, Margaret Doyle, Suzanna Talento, Waqas Ullah, Gregary D. Marhefka

Division of Cardiology Faculty Papers

We present a case of a 53-year-old woman with a history of ulcerative esophagitis and esophageal stricture status post esophageal stenting that was complicated by stent migration. She presented with fatigue, melena, and dark output from her percutaneous endoscopic gastrostomy tube. An echocardiogram showed hydropneumopericardium with cardiac tamponade physiology requiring emergent pericardiocentesis. The aspirated fluid was brown and cloudy; pathology of the fluid showed meat and vegetable matter consistent with food. She ultimately required esophagectomy with esophagostomy. This case highlights the importance of early recognition of esophageal-pericardial fistulas, as delay in the management carries a high risk for morbidity and …

Humanizing The Icu: Implementation Of Personalized Communication Boards In The Sicu Drives Enhanced Patient And Family Experience, Stephen D. Hoefler

Master's Theses

Objective: Research has established the importance of personalized communication in critical care settings, where standardized tools like whiteboards can improve patient and family engagement.

Aim: This project aims to develop a personalized communication board in the surgical intensive care unit (SICU) at a Bay Area academic quaternary care facility that, once implemented, will achieve at least 75% utilization in patient rooms by May 2025, enhancing communication and patient experiences.

Methods: Surveys were conducted with patients, families, and staff to gather stakeholder input and guide the design of a new standardized whiteboard model with personalized elements. Results: Based on stakeholder feedback, …

Mechanistic Insights Into The Flash Effect: The Role Of Oxygen And Radiation Chemistry In Ultra-High Dose Rate Radiation Therapy, Jacob Pierce Sunnerberg

Dartmouth College Ph.D Dissertations

The development of new cancer therapies focuses on widening the therapeutic ratio between tumor control and normal tissue toxicity. Over the last decade, ultra-high dose rate (UHDR) radiation therapy, commonly known as FLASH radiotherapy (FLASH-RT), has shown promising potential to reduce normal tissue toxicity while maintaining tumor control. However, the underlying mechanisms of the FLASH effect remain poorly understood. This thesis explores the radiation-chemical basis of FLASH-RT, focusing on the role of oxygen and reactive oxygen species in modulating biological outcomes.

A comprehensive set of in vitro studies demonstrated that UHDR delivery significantly alters radiation chemistry compared to conventional dose …

The Dubr/Mir-210-5p/Retsat Axis In Cholesterol-Associated Steatohepatitis: Clinical Signatures And Molecular Mechanisms, Hana Mahmoud Abdelzaher

Theses and Dissertations

Metabolic-associated fatty liver disease (MAFLD) represents an increasing global health challenge, with cholesterol-associated steatohepatitis (CASH) emerging as a distinct pathological entity warranting investigation. While CASH demonstrates unique features compared to traditional triglyceride-driven steatohepatitis, its underlying molecular mechanisms remain poorly understood. This study investigates a novel regulatory axis involving DPPA2 Upstream Binding RNA (DUBR), miR-210-5p, and retinol saturase (RETSAT). 170 patient samples revealed progressive axis dysregulation in disease states, with RETSAT emerging as a highly accurate diagnostic marker (AUC=1.000). Using novel in vitro models of MASH and CASH, we demonstrated that miR-210-5p modulation significantly affects lipid accumulation and cellular phenotype, with …

Development Of Preventive Dental Guidelines In The Primary Healthcare Setting In Egypt: A Delphi Method, Basant Mehriz

Theses and Dissertations

This study addresses the critical need for standardized preventive dental care guidelines within Egypt's primary healthcare system amid the rising burden of oral diseases. Through a systematic two-phase methodology combining a comprehensive literature review and a Delphi consensus-building process engaging 35 dental professionals, the research established priorities for contextually appropriate preventive measures. The consensus framework revealed strong support for clinical interventions (mean of 83% agreement), particularly fluoride-based prevention; community initiatives (mean of 83%), especially school-based programs; policy measures (mean of 77%) such as workforce and educational development, though with variable support for taxation and social determinants approaches. Statistical analysis demonstrated …

Effects Of Androgen Modifying Therapies On Disease Activity In Older Men With Multiple Sclerosis, Burcu Zeydan, Nur Neyal, Nabeela Nathoo, Manu Rangachari, Elizabeth J Atkinson, Jiye Son, Brittani L Conway, W Oliver Tobin, B Mark Keegan, Brian G Weinshenker, Kejal Kantarci, Jiwon Oh, Orhun H Kantarci

Faculty, Staff and Students Publications

Background: Anti-inflammatory properties of androgens were assessed in animal models, but only several clinical studies investigated the effects of androgen on multiple sclerosis (MS). Inflammatory activity in MS often attenuates with aging, and androgen modifying therapies (AMT), which mimic decreased androgen levels, are frequently used in older men. We aimed to investigate if the number of disease activity events would increase in older (≥55 years) male persons with MS (MPwMS) who are on AMT.

Methods: MPwMS with AMT initiation ≥55 years (AMT; n = 60) and without AMT history (no-AMT; n = 80) were included from a clinical-based observational study …

Transgenerational Obesity Modulation Of Gut Mucosal Immunity, Chen-Ting Hung, Justin Kern, Tihana Trsan, Santosh K Panda, Marie Laury, Umang Jain, Marco Colonna, Thaddeus S Stappenbeck, Ta-Chiang Liu

2020-Current year OA Pubs

The prevalence of obesity in the United States has continued to increase over the past several decades. A growing concern is that transgenerational effects of obesity negatively impact physiologic functions. We showed that consumption of a high fat, high sugar "Western" diet (WD) decreased the density of both gut innate (Paneth cells) and adaptive immune cells (intraepithelial lymphocytes; IEL). We asked whether consumption of WD impacts gut mucosal immunity in the offspring. WD-mediated Paneth cell loss was reversible, whereas IEL loss was not. However, the overall composition of the fecal microbiome and response to infection were defined by the diet …

Multidrug Resistance: Are We Still Afraid Of The Big Bad Wolf, Abdulelah Alhazza, Adenike Oyegbesan, Emira Bousoik, Hamidreza Montazeri Aliabadi

Pharmacy Faculty Articles and Research

After the era of multidrug resistance (MDR) against cytotoxic chemotherapy, the development of resistance against newly developed molecularly targeted drugs also seems inevitable. While the mechanisms involved in resistance against these two categories of anticancer drugs are different, the principles are similar: inherent resistance (also known as primary resistance) is a result of heterogeneity in cancer cells where a subpopulation of the cells do not show a favorable initial response to the drug, while acquired resistance (or secondary resistance), as the name suggests, is developed after repeated treatments due to the plasticity of cancer cells. Despite the introduction of a …

How Different Forms Of Exercise Affect Bone Mineral Density In Postmenopausal Women, Jonathan Mccanless

University Honors Theses

This paper analyzed 20 studies to understand how bone health in postmenopausal women is impacted by different forms of exercise. The primary aspect of bone health examined in this paper is bone mineral density (BMD). Resistance and impact training demonstrated clear signs of maintenance and increases in BMD, particularly in the lumbar spine and femoral neck. Aquatic exercise demonstrated mixed results in positively impacting BMD in a significant way, but it’s worth noting that there were still some signs of increased BMD. Impact exercise on its own can maintain BMD, and these effects can be seen in total hip BMD. …

Intrapersonal And Interpersonal Factors Of Participation In Physical Activity And Resistance Training In Adolescent Girls: A Narrative Review, Ben Banse-Fay

University Honors Theses

Low rates of participation in physical activity and resistance training among adolescent girls are a concern due to increased health and injury risks. Adolescent girls participate in physical activity and resistance training at a lower rate than boys, which may explain higher rates of injury. Research examining physical activity of adolescent girls often utilizes an ecological framework, identifying intrapersonal, interpersonal, and environmental factors. Of these ecological levels, intrapersonal and interpersonal factors are modifiable without large costs.

Therefore, this review aimed to identify and summarize recent research that explores the intrapersonal and interpersonal factors associated with participation in physical activity and …

Urban-Rural Divide In Inequality’S Impact On Substance Abuse, Jonathan E. Flores

Undergraduate Theses, Capstones, and Recitals

This thesis focuses on investigating the relationship between income inequality, measured through the Gini coefficient, and drug addiction, proxied through substance-related mortality. Specifically, this thesis focuses on how these dynamics vary across rural and urban counties in the United States, using population size as a proxy. County-level data from 2016 to 2020 were collected through both the CDC and the Census Bureau and subsequently analyzed using Stata, with crude death rates from drug and alcohol causes serving as a function of the Gini coefficient, labor force participation, racial composition, and other socioeconomic indicators. Through a quadratic version of the model, …