Medical Sciences Commons^™

Dosing Recommendations For Ampicillin And Ceftriaxone In The Treatment Of Pediatric Community-Acquired Pneumonia Using Monte Carlo- And Physiologic-Based Pharmacokinetic Simulations, Norint Tung, Dustin Huynh, Quang Dam, Tri Tran, Kristina G Hulten, Christopher J Harrison, Sheldon L Kaplan, Tyler H Do, Amartya Setty, Lana Hoang, John S Bradley, Jennifer Le

Faculty, Staff and Students Publications

Objective: Since 2011, Ampicillin (AMP) has been recommended as the parenteral antibiotic of choice for pediatric community-acquired pneumonia (CAP), but ceftriaxone (CRO) is recommended for unvaccinated children and those with complicated CAP. Using penicillin and CRO susceptibility data for pneumococcus, we evaluated the adequacy of currently recommended doses of AMP and CRO.

Methods: With nonlinear mixed-effects modeling v7.3, Monte Carlo simulations (MCS, N = 10,000) for AMP and CRO were conducted for 6 virtual patients aged 3 months, 1, 2, 5, 10, and 15 years. PK-Sim v9.0 was used to develop physiologic-based pharmacokinetic (PBPK) models for AMP (N = 4000) …

An Innovative Interprofessional Mock Trial Experience: Collaboration Between Emergency Medicine Residency Program And Law School As A Tool To Demonstrate Medical Malpractice Litigation, Adaeze Stephanie Onyechi, Cedric Dark, Vidya Eswaran

Faculty, Staff and Students Publications

Background: Due to the nature of the job and healthcare climate, emergency medicine physicians are constantly at risk for malpractice claims. Despite this, there is a gap in education around malpractice litigation. Given the considerable number of curricular topics residency programs must cover in conjunction with the volume of clinical hours residents work, we found that there is a need for an educational experience that is thorough yet compact enough to cause minimal disruption for educators and trainees. We created an easily reproducible educational session featuring collaboration between an emergency medicine residency program and a law school that covers medical …

Post-Tevar Type A Aortic Dissection: Insights And Future Directions, Jessica K Wang, Xander H T Wehrens, K Jane Grande-Allen

Faculty, Staff and Students Publications

No abstract provided.

Clinical Characteristics And Longitudinal Associations With Obsessive-Compulsive Disorder In Youth Exposed To Trauma, Caitlin M Pinciotti, Paul J Rathouz, Andrew G Guzick, Jeffrey D Shahidullah, Emily J Bivins, David B Riddle, Ogechi Cynthia Onyeka, Eric A Storch, Wayne K Goodman, Kelli Franco, Justin F Rousseau, D Jeffrey Newport, Karen Dineen Wagner, Charles B Nemeroff

Faculty, Staff and Students Publications

Childhood trauma exposure is associated with posttraumatic stress symptoms (PTSS) and suicidality, however it is also a risk factor for obsessive-compulsive disorder (OCD) in adults. Research examining the relationship between childhood trauma and OCD in youth is mixed, and there is a dearth of research examining the associations among OCD, PTSS, and suicidality. As a result, conclusions have been drawn from primarily cross-sectional adult samples. No study has examined the clinical characteristics associated with OCD in trauma-exposed youth, nor its associations with PTSS and suicidality over time. To address this gap, the present study used logistic regressions and generalized estimating …

"Touch&Play" Wood Typification By The Masspec Pen, Adriano Reis, Caroline Pais Carvalho, Iasmim Lopes De Lima, Felipe R P Mansoldo, Alane Beatriz Vermelho, Rosineide Costa Simas, Livia S Eberlin, Marcos N Eberlin

Faculty, Staff and Students Publications

We have investigated the ability of a MasSpec Pen (MSPen) "three-in-one" (extraction, transfer, and ionization) device coupled to a mass spectrometer to provide instantaneous chemical profiles that could promptly characterize wood samples from the mahogany (Meliaceae) family. For that, we selected a set of five representative wood species, that is, Brazilian mahogany (Swietenia macrophylla, also known as Honduran mahogany), two African mahoganies (Khaya ivorensis and Khaya senegalensis), and two "nongenuine" ("fake") mahogany woods: cedar (Cedrela odorata) and andiroba (Carapa guianensis). By simply touching the superficially polished wood surface and after 3 s of automatic extraction, profiles of highly characteristic markers …

Corrigendum To “Neuro-Ophthalmic Complications Following Eighth Cranial Nerve Microvascular Decompression” [Am J Ophthalmol Case Rep (2025) Ecollection 1–3 102258], Stanley M Saju, Patrick J Hunt, Pamela Davila-Siliezar, Noor Laylani, Andrew G Lee

Faculty, Staff and Students Publications

This corrects the article "Neuro-ophthalmic complications following eighth cranial nerve microvascularx decompression" in volume 37, 102258.

Graphage: Unleashing The Power Of Graph Neural Network To Decode Epigenetic Aging, Saleh Sakib Ahmed, Nahian Shabab, Abul Hassan Samee, M Sohel Rahman

Faculty, Staff and Students Publications

DNA methylation is a crucial epigenetic marker used in various clocks to predict epigenetic age. However, many existing clocks fail to account for crucial information about CpG sites and their interrelationships, such as co-methylation patterns. We present a novel approach to represent methylation data as a graph, using methylation values and relevant information about CpG sites as nodes, and relationships like co-methylation, same gene, and same chromosome as edges. We then use a graph neural network (GNN) to predict age. Thus our model, GraphAge leverages both the structural and positional information for prediction as well as better interpretation. Although, we …

Aged Regulatory T Cells Fail To Control Autoimmune Lacrimal Gland Pathogenic Cd4+ T Cells, Kaitlin K Scholand, Laura Schaefer, Gowthaman Govindarajan, Zhiyuan Yu, Jeremias G Galletti, Cintia S De Paiva

Faculty, Staff and Students Publications

CD25KO mice are a model of Sjögren disease. CD25KO mice have severe inflammation and infiltrating lymphocytes to the lacrimal glands (LG). Whether the pathogenicity of CD25KO CD4+ T cells can be controlled in vivo by Tregs is unknown. Eight-week-old B6 and CD25KO mice LGs were submitted for RNA bulk sequencing. A total of 3481 genes were differentially expressed in CD25KO LG compared to B6. Tear washing analysis identified CD25KO mice had elevated protein levels of TNF, IFN-γ, and CCL5 and decreased protein levels of IL-12p40 and VEGF-A. Co-adoptive transfer of CD25KO CD4+ T cells with either young or aged B6 …

Barriers To And Facilitators Of Sustaining A Systemic Lupus Erythematosus (Sle) Patient Decision Aid In Regular Rheumatology Outpatient Care In The Usa, Erin E Blanchard, Allyson G Hall, Ezra Gore, Parvaneh Yaghoubi Jami, Aizhan Karabukayeva, Larry R Hearld, Shelby Gontarz, Jasvinder A Singh

Faculty, Staff and Students Publications

Objective: This study investigates the barriers to and facilitators of sustaining a decision aid (DA) tool for patients with SLE in routine rheumatology outpatient care across the USA. The DA was initially developed for assisting patients with SLE in making informed medication choices by providing personalized information on their treatment process.

Methods: We conducted semi-structured interviews with clinicians, administrators, and information technology (IT) professionals from 15 geographically diverse rheumatology clinics that participated in a large-scale DA implementation trial. Interviews were transcribed and analysed using NVivo, with thematic coding to identify key factors influencing DA sustainability.

Results: The analysis identified several …

Bridging Genomics To Cardiology Clinical Practice: Artificial Intelligence In Optimizing Polygenic Risk Scores: A Systematic Review, Kaveh Hosseini, Nazanin Anaraki, Parham Dastjerdi, Sina Kazemian, Mandana Hasanzad, Mohamad Alkhouli, Mahboob Alam, Khurram Nasir, Jamal S Rana, Ami B Bhatt

Faculty, Staff and Students Publications

Despite advances in cardiovascular disease risk stratification, traditional risk prediction models often fail to identify high-risk individuals before adverse events occur, underscoring the need for more precise tools. Polygenic risk scores (PRS) quantify genetic susceptibility by aggregating genetic variants but face challenges in practice. This systematic review investigates how artificial intelligence (AI) and machine learning algorithms can optimize PRS (AI-optimized PRS) to improve cardiovascular disease prediction. Analyzing 13 studies, we found that AI-optimized PRS models enhance predictive accuracy by improving feature selection, handling high-dimensional data, and integrating diverse variables-including clinical risk factors, biomarkers, imaging, and combining multiple PRS. These models …

Fetal Body Composition In Twins And Singletons, Jessica L Gleason, Wesley Lee, Zhen Chen, Kathryn A Wagner, Dian He, William A Grobman, Roger B Newman, Seth Sherman, Robert Gore-Langton, Edward Chien, Luis Goncalves, Katherine L Grantz

Faculty, Staff and Students Publications

Importance: An emerging paradigm attributes third-trimester fetal growth deceleration in uncomplicated twin pregnancies to an evolutionary adaptive process. Evaluating longitudinal fetal soft-tissue development may provide important insights into differential fetal growth trajectories between twins and singletons.

Objective: To compare twin vs singleton lean and fat tissue growth across pregnancy.

Design, setting, and participants: Prospective cohort study of dichorionic twins and singletons with serial ultrasound scans to chart fetal growth (2009-2013) and collect fetal volume data to measure fat and lean tissue (2015-2019) in 12 US clinical centers. Participants were individuals with singleton (n = 2802 enrolled) and twin (n = …

Anti-Mullerian Hormone (Amh) Protects Ovarian Follicle Loss By Downregulating Granulosa Cell Function In In Vitro And In Vivo Models, Laura Detti, Michael C Mari, Michael P Diamond, Ghassan M Saed

Faculty, Staff and Students Publications

Purpose: AMH inhibits hormone production in luteinized granulosa cells (GCs) and stalls ovarian follicle development in vitro and in vivo. We sought to confirm AMH's mechanism of action through SMAD activation and investigate AMH inhibition of follicle development and function, in vitro and in vivo.

Methods: A primary culture of GCs isolated from follicular fluid was used, and cells were treated with recombinant AMH (rAMH) or placebo for 24 h. For the mouse model, 18-weeks old C57BL female mice were either euthanized at the beginning or treated with rAMH or normal saline for 3 weeks. Primordial (PDF), primary follicle (PRF), …

Association Between Timing Of Angiotensin Ii Administration And Outcomes In Vasoplegia After Cardiac Surgery, Travis J Miles, Michael T Guinn, Orlando R Suero, Todd K Rosengart, Marc R Moon, Joseph S Coselli, Ravi K Ghanta, Subhasis Chatterjee

Faculty, Staff and Students Publications

Objective: Vasoplegic shock after cardiopulmonary bypass (CPB) is a highly morbid condition. The novel vasopressor angiotensin II is increasingly being used for catecholamine-resistant vasoplegia. Although early intervention with adjunctive therapies such as methylene blue can improve outcomes of vasoplegia, the optimal timing for escalation with angiotensin II is unknown.

Methods: Pharmacologic data were extracted from electronic health records for patients who underwent surgery with CPB during 2017-2022. Patients were identified who received angiotensin II intraoperatively or postoperatively (ie, early or late). Multivariable logistic regression was used to determine the risk-adjusted effects of earlier angiotensin II administration on postoperative major adverse …

Norovirus Replication, Host Interactions And Vaccine Advances, B V Venkataram Prasad, Robert L Atmar, Sasirekha Ramani, Timothy Palzkill, Yongcheng Song, Sue E Crawford, Mary K Estes

Faculty, Staff and Students Publications

Human noroviruses (HuNoVs) are the leading cause of acute gastroenteritis worldwide in all age groups and cause significant disease and economic burden globally. To date, no approved vaccines or antiviral therapies are available to treat or prevent HuNoV illness. Several candidate vaccines are in clinical trials, although potential barriers to successful development must be overcome. Recently, significant advances have been made in understanding HuNoV biology owing to breakthroughs in virus cultivation using human intestinal tissue-derived organoid (or enteroid) cultures, advances in structural biology technology combined with epitope mapping and increased metagenomic sequencing. New and unexpected strain-specific differences in pandemic versus …

Dermatologic Fungal Neglected Tropical Diseases-Part I Epidemiology And Clinical Features, Kaya L Curtis, Jeremy A W Gold, Jana M Ritter, Theodore Rosen, Daniel Wagner C L Santos, Dallas J Smith, Shari R Lipner

Faculty, Staff and Students Publications

In this part 1 of a 2-part continuing medical education series, the epidemiology, clinical features, and diagnostic methods for fungal skin neglected tropical diseases (NTDs), which include eumycetoma, chromoblastomycosis, paracoccidioidomycosis, sporotrichosis, emergomycosis, talaromycosis, and lobomycosis, are reviewed. These infections, several of which are officially designated as NTDs by the World Health Organization, cause substantial morbidity and stigma worldwide and are receiving increased attention due to the potential for climate change-related geographic expansion. Domestic incidence may be increasing in the setting of global travel and immunosuppression. United States dermatologists may play a central role in early detection and initiation of appropriate …

The Efficacy Of Complementary And Alternative Medicines Utilized In Cosmetic And Surgical Dermatology: A Comprehensive Review, Promise Ufomadu, Bartley Joseph Gill, Theodore Rosen, Ikue Shmizu, Ida Orengo

Faculty, Staff and Students Publications

Background: Lately, there has been a growing demand for the utilization of complementary and alternative medicines (CAMs) with dermatological applications. This is true despite limited RCT-level studies on such agents. This presents a barrier for dermatologists and fellow clinicians in counseling patients who may be using or are tempted to use these CAM modalities. This review highlights CAM agents used by patients for applications in cosmetic and surgical dermatology, exploring their efficacy and toxicity profiles.

Methods: A comprehensive review was conducted on the effectiveness of several CAMs utilized in cosmetic and surgical dermatology by patients. A literature search was performed …

An Atypical Presentation Of Nodular Hidradenoma Of The Thigh Treated With Mohs Micrographic Surgery, Nabor S Mireles, Natalie H Garcia, Isabella Camacho-Hubbard, Abdul Hafeez Diwan, Jennifer S Ranario

Faculty, Staff and Students Publications

Nodular hidradenoma (NH) is a benign adnexal tumor demonstrating both eccrine and apocrine differentiation. NH generally presents as a slow-growing, solitary, firm nodule, most commonly measuring 0.5-2 cm in diameter. It most frequently occurs on the scalp, thorax, abdomen, and gluteal regions, with a predilection for adult women in their fourth to eighth decades of life. We report the case of a 41-year-old immunocompetent female who presented with a red, 3.6 × 2.5 cm nodule on the left thigh. Due to the cystic nature of the lesion, it was initially presumed to be a benign cyst. However, as the lesion …

Pedagogical Content Knowledge As A Lens For Transforming Teaching In Medical And Health Professions Education, Peter J Boedeker, Nancy P Moreno, Alana D Newell, Atul Maheshwari, Matthew A Mcmillin, Samantha P Tippen, Malford T Pillow, Andrew D Bergemann

Faculty, Staff and Students Publications

Pedagogical content knowledge (PCK) is the separate, topic-specific, specialized knowledge of educators that integrates subject matter expertise with effective teaching strategies in response to an identified learner misconception or to optimize teaching. Although PCK has been used for decades as a framework for understanding the often-tacit ability of an educator to educate well, little has been done to bring this framework into medical and health professions education. We provide examples of PCK in various contexts, including large -group lectures, problem-based learning sessions, and bedside teaching. Finally, we present a tool for capturing instances of PCK that can be used to …

Measles, Mumps, Rubella Immunization And The Resurgence Of Measles In America, Peter J Hotez

Faculty, Staff and Students Publications

No abstract provided.

Fine-Scale Population Structure Of Japanese Helicobacter Pylori Provides New Anthropological And Epidemiological Insights, Kohei Tomonari, Batsaikhan Saruuljavkhlan, Ricky Indra Alfaray, Kartika Afrida Fauzia, Osamu Matsunari, Daisuke Chinda, Tadashi Shimoyama, Phawinee Subsomwong, Nagisa Kinjo, Tetsu Kinjo, Yasuo Hanamure, Masato Shinzato, Rumiko Suzuki, Fukunori Kinjo, Shigeru Takigami, Toshio Fujioka, Takeshi Matsuhisa, Junko Akada, Takashi Matsumoto, Yoshio Yamaoka

Faculty, Staff and Students Publications

Helicobacter pylori is considered to contribute to gastric cancer and is also used as a marker to trace human migration due to its co-evolution with humans. To understand the recently proposed tripartite model suggesting three ancestral origins for the Japanese population and address the enigma of the high incidence of gastric cancer in Northeast Hondo (Hondo is mainland Japan), we conducted a fine-scale population structure analysis using a large Japanese H. pylori dataset, including 438 strains from 9 regions based on whole-genome sequences. As a result of fineSTRUCTURE analysis, it was found that H. pylori in Northeast Hondo is genetically …

Eye Catching, Alec B Rezigh, Anand D Jagannath, Austin C Rezigh, Ann Marie Kumfer, Stephanie V Sherman

Faculty, Staff and Students Publications

A 55 year-old man with type 2 diabetes mellitus presented to the emergency department with subacute nausea, vomiting, and abdominal pain. He was found to have epididymitis and hyperglycemia that improved with antibiotics and supportive care. However, he was also discovered to have significant acute kidney injury and chronic, relapsing-remitting bouts of eye pain and redness, confirmed to be uveitis on ophthalmologic evaluation. Despite completing an appropriate course of antibiotics, his pyuria and kidney injury persisted. An extensive infectious, autoimmune, and malignancy work-up was negative. As such, renal biopsy was pursued and revealed findings consistent with tubulointerstitial nephritis. With a …

Dietary Interventions To Support And Improve Sleep Disturbances And Insomnia Disorder In Menopause: From Bench To Bedside, Rosie H Musgrave, Sara Nowakowski, Tamlyn J Watermeyer, Emily J Arentson-Lantz, Greg J Elder

Faculty, Staff and Students Publications

Sleep is essential for maintaining physical and psychological health, and also cognitive health (referred to as 'brain health'). However, the transition to menopause has a direct impact upon sleep. Sleep disturbances are reported by approximately 40%-60% of menopausal women, and insomnia disorder is also prevalent. Diet-based interventions could potentially be used to improve subjective sleep quality in this population, and although there are several promising interventions which have been used in other groups that could be trialled, the evidence base is currently lacking. One particularly promising area for future research is that these interventions might be used alongside, or instead …

Performance Of Stool-Based Molecular Tests And Processing Methods For Paediatric Tuberculosis Diagnosis: A Systematic Review And Meta-Analysis, Lucía Carratalà-Castro, Shilzia Munguambe, Belén Saavedra-Cervera, Petra De Haas, Alexander Kay, Olivier Marcy, Pamela Nabeta, Willy Ssengooba, Elisabetta Ghimenton-Walters, Sozinho Acácio, Maryline Bonnet, Joanna Ehrlich, Andrew R Dinardo, Anca Vasiliu, Christoph Lange, Sabine Hermans, Anna M Mandalakas, Elisa López-Varela, Alberto L García-Basteiro

Faculty, Staff and Students Publications

Background: There has been a global pursuit to improve the diagnosis of tuberculosis in young children by applying diagnostic methods on accessible biospecimens such as stool. We aimed to conduct a systematic review on the accuracy of stool-based molecular tests for tuberculosis diagnosis in children and to assess the impact of the available pre-processing methods and other design characteristics.

Methods: In this systematic review and meta-analysis, we evaluated studies in children younger than 16 years with presumptive tuberculosis that were published in English, Spanish, French, and Portuguese from Jan 1, 2000, to May 3, 2024, in MEDLINE, Embase, and Embase …

Epidemiology Of Intestinal Parasite Infections And Multiparasitism And Their Impact On Growth And Hemoglobin Levels During Childhood In Tropical Ecuador: A Longitudinal Study Using Molecular Detection Methods, Rojelio Mejia, Irina Chis Ster, Martha E Chico, Irene Guadalupe, Andrea Arévalo-Cortés, Andrea Lopez, Aida Y Oviedo-Vera, Philip J Cooper

Faculty, Staff and Students Publications

Background: There are few longitudinal epidemiological studies of intestinal parasitic infections (IPI) and their health effects. We studied the epidemiology and determinants of IPI and multiparasitism during childhood using molecular methods for parasite detection and analysed their effects on growth and hemoglobin levels.

Methods: Random sample of 401 children from an Ecuadorian birth cohort followed up to 8 years of age. Data on environmental and sociodemographic characteristics were collected by questionnaires. Stool samples were collected, and weight, height, and hemoglobin levels were measured at 7 and 13 months, and 2, 3, 5, and 8 years. Stool samples were analysed using …

Corrigendum To "Effects Of Dialysate Potassium Concentration Of 30 Mmol/L With Sodium Zirconium Cyclosilicate On Dialysis-Free Days Versus Dialysate Potassium Concentration Of 20 Mmol/L Alone On Rates Of Cardiac Arrhythmias In Hemodialysis Patients With Hyperkalemia" Kidney International 2025;107:169-179, David M Charytan, Wolfgang C Winkelmayer, Christopher B Granger, John P Middleton, Charles A Herzog, Glenn M Chertow, James M Eudicone, Jeremy D Whitson, James A Tumlin, Adapt Investigators

Faculty, Staff and Students Publications

No abstract provided.

Protein Biomarkers Of Interstitial Lung Abnormalities In Relatives Of Patients With Pulmonary Fibrosis, Jonathan A Rose, Mark P Steele, Esteban J Kosak Lopez, Gisli Thor Axelsson, Andrea G Galecio Chao, Alan Waich, Katie Regan, Swati Gulati, Anthony H Maeda, Sharmin Sultana, Claire Cutting, Ann-Marcia C Tukpah, Andrew J Synn, Mary B Rice, Hilary J Goldberg, Joyce S Lee, David A Lynch, Rachel K Putman, Hiroto Hatabu, Benjamin A Raby, David A Schwartz, Ivan O Rosas, Gary M Hunninghake

Faculty, Staff and Students Publications

Rationale: First-degree relatives of patients with pulmonary fibrosis (referred to here as relatives) are at high risk for interstitial lung abnormalities (ILA), highlighting the need for biomarkers for risk prediction. We aimed to identify blood proteins associated with and predictive of ILA among relatives of patients with pulmonary fibrosis.

Methods: Relatives enrolled in two independent cohorts had protein levels measured using an aptamer-based proteomic platform. ILA were assessed with computed tomography scans as per Fleischner Society recommendations. Protein associations with ILA were assessed using regression. Significant proteins were used with clinical variables to detect ILA.

Results: Of 237 relatives from …

Targeting S1pr2 In Sepsis, One Fragmented Mitochondrion At A Time, Chao He, Jennifer L Larson-Casey

Faculty, Staff and Students Publications

No abstract provided.

Airway Immune Signatures In Severe And Fatal Infection With Covid-19, Naresh Doni Jayavelu, Jing Jing Qi, Slim Fourati, Farrah Kheradmand, Charles R Langelier, Lauren I R Ehrlich, Joann Diray-Arce, Annmarie Hoch, Monica Kraft, Patrice M Becker, Matthew C Altman, Ruth R Montgomery

Faculty, Staff and Students Publications

No abstract provided.

Parp Inhibitor Response Is Enhanced In Prostate Cancer When Xrcc1 Expression Is Reduced, Kaveri Goel, Vani Venkatappa, Kimiko L Krieger, Dongquan Chen, Arun Sreekumar, Natalie R Gassman

Faculty, Staff and Students Publications

Prostate cancer (PCa) is the second most common cancer worldwide and the fifth leading cause of cancer-related deaths among men. The emergence of metastatic castration-resistant prostate cancer (mCRPC) after androgen deprivation therapy (ADT) exemplifies the complex disease management for PCa. PARP inhibitors (PARPis) are being tested to treat mCRPC in tumors with defective homologous recombination repair (HRR) to address this complexity. However, increasing resistance towards PARPi in HRR-deficient patients and the low percentage of HRR-defective mCRPC patients requires the identification of new genes whose deficiency can be exploited for PARPi treatment. XRCC1 is a DNA repair protein critical in the …

Stress, Employment Changes, And Psychological Distress Among Caregivers Of Patients With Head And Neck Cancer, Lama Abdurrahman, Vlad C Sandulache, Cielito Reyes-Gibby, Erich M Sturgis, Pavan Jhaveri, Hoda Badr

Faculty, Staff and Students Publications

Importance: Patients undergoing external beam radiation therapy (EBRT) for head and neck cancer (HNC) often experience adverse effects that require substantial caregiving. The burdens of caregiving can impact caregiver employment and mental health over time, yet this topic remains underexplored.

Objective: To examine the associations between caregiving for patients with HNC who undergo EBRT and caregiver stress, employment status, and psychological distress.

Design, setting, and participants: This was a secondary analysis of data from a longitudinal survey study that surveyed caregivers at baseline (ie, at initiation of EBRT) and at 4-month and 12-month follow-ups. The study was conducted at 2 …