Medical Specialties Commons^™

Tales From The Cryptogenic: A Case Of Recurrent Major Cryptogenic Stroke, Harpreet Matharu, Kennedy Aikins, Kumail Rizvi, Danielle Ford

North Texas GME Research Forum 2026

Background

It is estimated that 30 to 40% of all strokes have no identifiable cause; these are classified as cryptogenic strokes. Often, the unknown nature is secondary to delayed or incomplete investigation of cerebrovascular pathology. At times, strokes are considered truly cryptogenic as extensive stroke workup leads to no identifiable cause or etiology. Acute ischemic strokes in young adults without identifiable risk factors present a diagnostic and therapeutic challenge. Prompt recognition and treatment are critical to optimize outcomes.

Case Presentation

A 32-year-old African American male with a past medical history of a cerebrovascular accident in 2023 at an outside hospital …

Pigmented Villonodular Synovitis (Pvns) After A Distal Femur Non-Union: A Case Report, Troy Puga, Jenna Chrabolowski, Mckenna W. Box, Kisan Parikh

North Texas GME Research Forum 2026

Background Pigmented villonodular synovitis (PVNS) is a rare benign neoplastic process that involves extensive proliferation of the synovium of a joint. Development of PVNS has been potentially linked to traumatic etiologies, however, evidence for this remains limited. This case report aims to present a case of PVNS that developed after a traumatic etiology.

Case Presentation A 62 year old female presented with recurrent left knee effusion and non-union of the left distal femur roughly four years after an MVC and index open reduction and internal fixation with a lateral locking plate and screw construct. Left knee aspiration at initial visit …

True Love: Heart Says To The Kidneys ‘Don’T Fail Me’, Greeshma Molugu, Srinivasan Rajaganapathy, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Valvular calcification is an increasingly important cardiac valvular pathology in end-stage renal disease (ESRD) patients, most frequently involving the aortic and mitral valves. The incidence/prevalence of mitral annular calcification in ESRD patients is about 30%, with mitral stenosis occurring in less than 5%. Various predisposing factors for valvular calcification in ESRD patients include age (median age >/= 60 years), hypertension, diabetes, use of calcitriol and calcium-containing phosphate binders, secondary hyperparathyroidism and duration of dialysis (median duration of >/= 5 years). We present a rare case of a young male with ESRD on peritoneal dialysis (PD) for less than two …

Invasive Pulmonary Aspergillosis: A Two-Year Journey, Jason Woods, Padmaditya Sureddi, Nga Van, Danielle Ford

North Texas GME Research Forum 2026

BACKGROUND: Highly active anti-retroviral therapy (HAART) has decreased the incidence of opportunistic infections among persons with HIV. Invasive aspergillosis specifically is uncommon among individuals with clusters of differentiation 4 (CD4) count >100 cells/mm3. Furthermore, treatment of aspergillosis in the HIV-infected population has not been examined systematically. We report a patient with CD4 count >200 cells/mm3, compliant with HAART therapy who developed invasive pulmonary aspergillosis (IPA) over the course of two years that was successfully treated through a combination of bronchial artery embolization and liposomal amphotericin.

CASE PRESENTATION: A 56-year-old man from southern Africa with four-year history of HIV-1 on HAART …

White Plaques With High Stakes: A Case Of Esophageal Leukoplakia, Boney Lapsiwala, Ritika Sharma, Karthik Kasireddy, Devika Pavuluri, Rupali Prabhukhot, Amjad Awan

North Texas GME Research Forum 2026

Introduction: Esophageal leukoplakia, also termed esophageal epidermoid metaplasia (EEM), is a rare esophageal epithelial disorder characterized by keratinized squamous plaques on esophagogastroduodenoscopy (EGD). With a prevalence of < 0.5%, it is often incidentally identified during evaluation for nonspecific upper gastrointestinal symptoms. EEM is considered a premalignant condition due to its association with esophageal squamous cell carcinoma (SCC), yet management and surveillance strategies remain undefined.

Case Presentation: A 65-year-old woman with hypothyroidism, hypertension, hyperlipidemia, and remote aplastic anemia treated with bone marrow transplantation 35 years prior presented with chronic cough and progressive dysphagia to solids and liquids. She denied tobacco, alcohol, or illicit drug use. No weight loss, abdominal pain, or blood in stool was noted. CT of the neck with contrast revealed curvilinear mucosal hyperenhancement involving the mid to distal thoracic esophagus without lymphadenopathy. Physical examination and …

The Unlikely Case Of Sporadic Immune Thrombotic Thrombocytopenic Purpura With Refractory And Seizure-Like Activity Features: Case Report, Brandon Gremmer, Alain Folefack

North Texas GME Research Forum 2026

Introduction/Background: Thrombotic Thrombocytopenic Purpura (TTP) is a multisystem disease that can lead to multiorgan failure by disseminated mechanical destruction, microangiopathic hemolytic anemia, and thrombocytopenia. Most TTP cases are classified as acquired or hereditary; however, sporadic immune TTP with a refractory episode during the same hospital admission is not well documented in the literature. Furthermore, seizure-like activity during plasma exchange is not a common adverse effect.

Case Presentation: A 35-year-old African American female with no documented medical, surgical, or social history, changes to medications, or lifestyle changes presented with full body fatigue, fever, loss of balance, and confusion. On arrival, labs …

Case Of Toxic Epidermal Necrolysis With High Body Surface Area Involvement And Review Of Predictors Of Severity Of Illness, Hannah R. Riva, Clay J. Cockerell, Muhammad T. Siddique, James M. Cross

North Texas GME Research Forum 2026

BACKGROUND: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare and potentially fatal cutaneous adverse drug reactions. The most common mortality predictor used for TEN is the SCORTEN (Severity-of-Illness Score for Toxic Epidermal Necrolysis). Various scoring systems have been used and are being developed for predicting mortality and guiding treatment in SJS/TEN. We describe a case of TEN with a high body surface area involvement and discuss the scoring predictors for severity of illness.

CASE PRESENTATION: A 63-year-old male was transferred to our burn center for a suspected diagnosis of SJS/TEN. He was intubated prior to arrival. He …

Devising A Protocol For Mri Clearance In Patients With Cardiac Implantable Electronic Devices (Cied), Sienna Luk, Alvin Mathew, Darshan Bhatty, Kamran Rizvi

North Texas GME Research Forum 2026

Background: Magnetic Resonance Imaging (MRI) in patients with Cardiac Implantable Electronic Devices (CIEDs) remains a logistical challenge in many clinical settings. At Medical City Denton, the absence of a standardized institutional policy has led to significant inefficiencies, including prolonged hospital stays and increased healthcare costs. The primary objective of this project was to address these barriers by developing a streamlined, evidence-based protocol to improve care coordination and resource utilization for patients with CIEDs requiring diagnostic imaging.

Methods: Launched in 2026, this pilot initiative utilized a multi-stakeholder approach involving hospitalists, EPs, radiology staff, and device representatives. A core component of the …

Relationship Between Exception Request For Higher Listing Urgency And Aggressiveness In Accepting Heart Offers, Jorim Parmar, Yingxian Liu, Devika Adusumilli, Luke Taylor, Shakir Al-Ezzi, Usman Khan, Claudio Bravo, Claudius Mahr, Song Li

North Texas GME Research Forum 2026

BACKGROUND: Transplant programs may submit exception requests to upgrade a listed patient’s priority, often anticipating a higher likelihood of accepting marginal or high-risk donor organs. This study explores whether exception request status is associated with increased risk tolerance in organ acceptance.

METHODS: We conducted a retrospective analysis using data from the Scientific Registry of Transplant Recipients (SRTR), focusing on adult patients (≥18 years) listed for heart transplantation. Statistical analyses were performed using SAS/STAT 14.1. Descriptive statistics summarized demographic and clinical variables. Baseline characteristics were compared between recipients with and without exception requests. Primary analysis: Mixed-effects linear regression was used to …

Reducing Respiratory Viral Testing In A Pediatric Emergency Department: A Quality Improvement Initiative, Anna Suessman

North Texas GME Research Forum 2026

Background: Respiratory viral testing in pediatric emergency departments (EDs) is frequently performed despite limited impact on clinical management for many low-risk presentations. Unnecessary testing increases cost and operational burden may delay patient throughput and can provide false reassurance to caregivers. Additionally, pediatric emergency department nurses agreed with overburden and impact to throughput based on overuse of viral testing (qualitative nursing survey conducted on September 4, 2024 showed >98% felt testing was unnecessary). We hypothesized that reducing testing through standardized team education and discharge processes would not negatively affect patient experience. This initiative aimed to decrease unnecessary respiratory viral testing during …

Impact Of Mips Measure 66 On The Incidence Of Pta's, Sydney Finch, Christopher Houston

North Texas GME Research Forum 2026

INTRO

A number of randomized controlled trials indicate that using point-of-care group A strep (POC GAS) testing decreases antibiotic utilization without compromising health outcomes. In 2018, the Merit-based Incentive Payment System (MIPS) measure 66 went into effect requiring the testing for GAS when treating pharyngitis. The intent was to decrease the unnecessary use of antibiotics in the treatment of pharyngitis, given that most cases are viral. Anecdotally, some physicians have noticed the increased incidence of peritonsillar abscesses (PTA). Our research group aims to investigate if there has been a significant increase in incidence of PTAs after the implementation of MIPS …

Cost Effectiveness Of Lifestyle Program For Diabetes Remission In The Era Of Glp-1, Prasanthi Tondapu, Haasini Sunkavalli, Micaela C. Karlsen, Kara L. Staffier, Kathryn J. Pollard, Surabhi Naik

North Texas GME Research Forum 2026

BACKGROUND: GLP-1 receptor agonists are popular for managing type 2 diabetes (T2D) and obesity but are costly and can result in side effects including weight rebound. Intensive therapeutic lifestyle change (ITLC) programs present an effective alternative, facilitating an HbA1C (A1C) less than 6.5% for 3 months without medication and long-term weight control.

CASE PRESENTATION: We present a 69-year-old Black man with T2D, hypertension, chronic kidney disease, obesity, and sleep apnea. In 2023, he was hospitalized with a blood glucose of 800 mg/dL and A1C 10.8% and discharged on insulin. And, with a BMI of 32 kg/m2 and weight of 238.6 …

A Storm At Both Ends: Hypertensive Emergency Unmaksing C3-Dominant Glomerulonephritis, Karthik Kasireddy, Boney Lapsiwala, Marisha Sharma, Rupali Prabhukhot, Victor Canela

North Texas GME Research Forum 2026

Background: C3 glomerulopathy (C3G) encompasses a group of diseases that result from abnormalities in the alternative pathway of complement regulation, and has been defined by C3 only or C3-dominant immunofluorescence staining seen on renal biopsy. C3G includes C3 glomerulonephritis (C3GN) and dense deposit disease (DDD); the latter of which is characterized ultra-structurally by the presence of highly osmiophilic intramembranous deposits. Both C3GN and DDD often present with a membranoproliferative pattern of glomerular injury, a finding that can also be seen in thrombotic microangiopathy (TMA). Most common causes include infection, autoimmune and monoclonal gammopathy.

Case presentation: A 70-year-old man with hypertension, …

Rare Presentation Of Diffuse B-Cell Lymphoma (Dlbcl), Jasmine M. Silva, Vinay Antin

North Texas GME Research Forum 2026

No abstract provided.

Gastroparesis As Initial Feature Of Neuromyelitis Optica Spectrum Disorder, Jasmine M. Silva, Jorim J. Parmar, Shivani Gandhi, Sreevani Gudiseva

North Texas GME Research Forum 2026

No abstract provided.

Internal Jugular Injuries: Outcomes From The American Association For The Surgery Of Trauma Prospective Observational Vascular Injury Treatment (Proovit) Multicenter Registry, April Miller, Pranay Arora, Devika Pavuluri, John Bini

North Texas GME Research Forum 2026

Introduction: Since March 2013, the PROOVIT database has been a prospective, multi-center observational trial established for the study of vascular trauma. Here we present the data for the management of internal jugular vein injuries due to blunt and penetrating trauma.

Methods: Inclusion criteria for the PROOVIT study included patients age >2 years with radiologic or clinical/operative diagnosis of injury to named vessels in trauma patients at participating facilities. The database was reviewed to examine injury presentation, surgical management, postprocedural medical management with antiplatelet or anticoagulant therapy, and mortality. SPSS software was used to perform the descriptive and exploratory analysis for …

Surgical Management Of A Giant Colonic Diverticulum, Courtney Koplyay, Mason Workman, Michael Truitt, Muhammad T. Siddique

North Texas GME Research Forum 2026

INTRODUCTION: Giant colonic diverticulum (GCD), defined as a diverticulum >4 cm, is a rare manifestation of diverticular disease with less than 200 reported case reports. CT imaging is the preferred imaging modality to identify and confirm the presence of a GCD, which provides an accurate depiction of the size, location, and contents of the diverticulum GCD can present with nonspecific abdominal symptoms, abdominal pain, bloody stools, or an enlarging mass. Given the risk of serious complications, including diverticulitis, bowel obstruction, and perforation, early recognition and management are essential to prevent further complications. Surgical management with diverticulectomy or partial colectomy is …

Too Young For A Broken Heart: Stemi At Twenty, Shana-Kay Lambert-Johnson, Jason Thompson

North Texas GME Research Forum 2026

Background: ST-elevation myocardial infarction (STEMI) is exceptionally rare in young adults, accounting for less than 1% of acute coronary syndromes in individuals younger than 35 years. When it occurs in early adulthood, particularly among women, it introduces diagnostic uncertainty and exposes gaps in post-discharge continuity of care. This case of a 20-year-old female with STEMI highlights the role of primary care in preserving evidence-based therapy while addressing psychosocial determinants of recovery.

Case Presentation: A 20-year-old female presented to her primary care clinic for post-discharge follow-up after hospitalization for an anterior STEMI that began with sudden-onset substernal chest pain radiating to …

Gastroduodenal Artery Coil Erosion Causing Pyloric Obstruction And Upper Gi Bleeding, Corey Newman, Mahad Rehman, Cody Beltran, Michael Carrick

North Texas GME Research Forum 2026

Background Trans-arterial embolization (TAE) of the gastroduodenal artery (GDA) is a well-established and effective treatment for peptic ulcer bleeding and visceral pseudoaneurysms. Although generally safe, delayed migration or erosion of embolization coils into the gastrointestinal lumen is a rare but recognized complication that may occur months to years after the procedure. Proposed mechanisms include ischemic mucosal injury, mechanical pressure from the coil mass, and chronic inflammation. Clinical manifestations vary widely, ranging from occult bleeding and ulceration to perforation or gastric-outlet obstruction. Only a limited number of cases describing GDA coil erosion presenting with both bleeding and obstruction have been reported. …

Association Of Glp-1 Receptor Agonist Use With Postoperative Outcomes After Rotator Cuff Repair In Patients With Diabetes: A Propensity Score–Matched Analysis, Mckenna W. Box, Troy B. Puga, Hans Drawbert, Aysu Erdemir, John T. Riehl

North Texas GME Research Forum 2026

Background Diabetes impairs tendon healing after rotator cuff repair (RCR), with early postoperative poor glycemic control linked to a higher failure risk in studies. GLP-1 receptor agonists (GLP-1RAs) are increasingly used for glycemic control. Preclinical studies indicate that GLP-1RA may benefit rotator cuff healing through anti-inflammatory mechanisms as well. However, real-world data on the effects of GLP-1RAs on RCR outcomes remain incompletely understood.

Methods We conducted a retrospective cohort study using an institutional dataset (01/01/2016 to 09/30/2024) of adults aged 18-74 years with type 2 diabetes who underwent RCR. GLP-1RA exposure was established by home medication lists. Patients with autoimmune …

Retrospective Analysis Of Predictive Accuracy In Applying The Nih Stroke Scale, Rachel Hoang, Ray Rahimi, Kelly Mofor, Charley Meadows, Ty Shields, Hibba Thayyil, Hannah A. Affleck, Parker Owen, Sanjay Sharma

North Texas GME Research Forum 2026

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is widely used to quantify neurologic deficits in acute stroke, yet it is based on observable symptoms rather than ischemic stroke pathophysiology. Because ischemic stroke typically results from focal vascular occlusion, deficits classically localize to a single hemisphere and do not cross the midline. The frequency with which patients presenting with bilateral or contralateral symptoms have MRI-confirmed ischemic infarction, compared with those with unilateral deficits, remains unclear.

METHODS: We performed a retrospective analysis of patients for whom a code stroke was activated at a single institution. Patients presenting with bilateral/contralateral or …

A Lethal Connection Uncovered: Direct Endoscopic Evidence Of A Primary Aortoenteric Fistula, Joel Mathews, Trina Lewis, Munazzah Kaleem, Long Hoang

North Texas GME Research Forum 2026

BACKGROUND: Primary Aortoenteric Fistulas (PAEFs) are a rare condition that occurs when the native aorta develops an abnormal connection with the gastrointestinal lumen. PAEFs tend to develop within the duodenum, specifically the distal region of the third part of the duodenum, which is retroperitoneal and is anterior to the aorta. Duodenal PAEFs can be difficult to diagnose and are often lethal, given their non-specific presenting symptoms and rapid progression to hemorrhagic shock.

CASE PRESENTATION: This case focuses on a 70-year-old male with a history of T4N2 colon adenocarcinoma with hemicolectomy, active smoking, and abdominal aortic aneurysm (AAA) who was transferred …

Esophageal Squamous Cell Carcinoma Incidentally Detected On Barium Swallow: A Case Report, Muhammad Rubeel Akram, Aditya Rao, Muhammad T. Siddique

North Texas GME Research Forum 2026

Background: Esophageal cancer is an aggressive malignancy with a poor prognosis, and has high rates of recurrence despite curative-intent therapy. While endoscopy with biopsy remains the gold standard for diagnosis, non-diagnostic imaging studies are performed when evaluating for dysphagia, and may bring to light underlying pathology, warranting further workup. Surgical resection following neoadjuvant chemoradiation is often performed, but postoperative complications and disease recurrence are important concerns. This case highlights the crucial role of early detection via imaging and the clinical burden associated with esophageal squamous cell carcinoma.

Case Presentation: A 76-year-old female presented with dysphagia and underwent a barium esophagogram, …

Analysis Of Stemi Activations, Ashleigh Wilson, Christopher Houston

North Texas GME Research Forum 2026

Background Prior studies of ST-segment elevation myocardial infarctions (STEMI) presentations have shown that longer door-to-balloon (D2B) times are associated with increased mortality. Percutaneous Coronary Intervention (PCI) within 90-minutes is standard. It appears that STEMI patients without prehospital notifications have longer ischemic times. Prehospital activation of cathlab involves EKG transmission that the Emergency Physician interprets before activating cathlab, which has the potential to cause delays. We propose that prehospital notification and prehospital having the ability to activate cathlab could decrease D2B times.

Study aims:

• Evaluate current prehospital notification system.
• Assess EMS accuracy in STEMI identification and cathlab activation. 
• Does prehospital notification …

An Unusual Case Of Genetic Dilated Cardiomyopathy Unmasked By Covid-19 Infection, Greeshma Molugu, Daniel Mcmahan, Seline Haci, Giridhar Mundluru, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Titin (TTN) mutations are a well-known cause of dilated cardiomyopathy (DCM), occurring in approximately 25% of familial cases of idiopathic DCM and 18% of sporadic cases. Recognition and referral for genetic testing remains underutilized but has important prognostication and helps the patient better understand the disease transmission. This case report stresses the importance of a complete evaluation for genetic causes of DCM.

Case Presentation: A 21-year-old male who was adopted as an infant was hospitalized with COVID-19 infection and diagnosed with non-ischemic cardiomyopathy with an initial left ventricular ejection fraction (EF) of 10%. He was assumed to have DCM …

Cor Triatriatum Sinistrum: An Underrecognized Indication For Anticoagulation, Boney Lapsiwala, Karthik Kasireddy, Tenna Mathew, Babu Makkena

North Texas GME Research Forum 2026

Background: Cor triatriatum (CTS) is a rare congenital heart defect in which a fibromuscular membrane divides the atrium into two chambers, disrupting normal blood flow and potentially leading to circulatory impairment. Accounting for 0.1% to 0.4% of congenital heart diseases, CTS presents variably depending on the degree of left atrial obstruction. Patients may report exertional dyspnea, orthopnea, or palpitations; severe cases can progress to heart failure, pulmonary hypertension, or thromboembolic events. We present the case of a young adult male who developed symptomatic heart failure and atrial fibrillation and was incidentally found to have CTS on imaging.

Case presentation: A …

Prognostic Value Of Systemic Inflammatory Indices For Predicting Mace In Nstemi Patients Undergoing Pci, Boney Lapsiwala, Aditya Sharma, Usman Khan, Jorim Parmar, Justin Soloman, Veeranna Vibhuti, Mehdi Khalafi

North Texas GME Research Forum 2026

Background: Cardiovascular diseases (CVD) account for nearly one-third of global mortality, with ischemic heart disease caused by a mismatch between myocardial oxygen supply and demand. Despite advances in percutaneous coronary intervention (PCI) and contemporary pharmacotherapy, patients with non–ST-segment elevation myocardial infarction (NSTEMI) continue to experience substantial residual risk for major adverse cardiovascular events (MACE). As traditional risk stratification tools have limited ability to identify high-risk individuals, interest has shifted toward biomarkers reflecting inflammatory pathways central to atherosclerosis and plaque instability. Hematologic inflammatory markers including pan inflammatory value (PIV), systemic immune inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) initially …

A Not So Typical Case Of Alcoholic Pancreatitis, Wendy Phillips, Kaleem Munazzah, Asad Rehman, Robert Keller

North Texas GME Research Forum 2026

BACKGROUND Acute pancreatitis (AP) has become one of the leading gastrointestinal diagnoses resulting in inpatient hospitalization¹. AP is diagnosed by meeting two of three criteria: characteristic clinical presentation, biochemical evidence (elevated lipase or amylase levels), and imaging findings with pancreatic inflammation. Gallstones and heavy alcohol use account for most cases (40%–70% and 25%–35%, respectively). Hypertriglyceride induced AP (HTG-AP) accounts for only about 7-10% of AP cases³ and often tends to present in younger, male, obese, patients with a higher rate of diabetes¹. Below we present a unique case of a coinciding alcoholic and HTG - AP in an otherwise healthy …

Double Trouble: A Rare Co-Existence Of Hypertrophic Obstructive Cardiomyopathy And Anomalous Origin Of The Right Coronary Artery, Greeshma Molugu, Srinivasan Rajaganapathy, Seline Haci, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Hypertrophic obstructive cardiomyopathy (HOCM) and anomalous origin of the right coronary artery (RCA) are well-known but rare congenital heart diseases that are recognized as independent leading causes of sudden cardiac death(SCD). The independent prevalence of both these conditions is less than 1%. The co-occurrence of these two conditions is seldom ever reported in the literature. We present an extremely rare case of HOCM and the anomalous origin of the RCA in the same individual.

Background: A 67-year-old male with no significant past medical history presented for chest pain and palpitations. EKG showed atrial fibrillation with rapid ventricular response. Troponin …

Expert Consensus On Osteoporosis Risk Management In Patients With Sleep Disorders, Siqi Leng, Jinming Yang, Yuming Jin, Jie Shi, Ye Zhang, Junying Zhou, Lusi Tan, Taomei Li, Peiyan Ni, Kejia Hu, Yuan Shi, Jiamin Liao, Yun Li, Pei Xue, Christian Benedict, Alexandros N. Vgontzas, Michael Furian, Talant Sooronbaev, Naima Covassin, Virend K. Somers, Zhoulong Yu, Hongqiang Sun, Xiao Tan, Jihui Zhang, Yun Kwok Wing, Yue Leng, Larry D. Sanford, Michael V. Vitiello, Katie L. Stone, Rong Ren, Lin Lu, Xiangdong Tang

Department of Biomedical and Translational Sciences Faculty Publications

A rate-limiting step in the prevention and early intervention of osteoporosis is identifying its asymptomatic onset. Accumulating evidence shows that sleep disorders are associated with an increased risk of osteoporosis. Given their early detectable and modifiable nature, integrating sleep disorder management into osteoporosis prevention and care pathways offers a novel approach for enhancing skeletal health. This expert consensus represents a collaborative effort by specialists in sleep medicine and orthopedics from across the world, integrating epidemiological, mechanistic, and interventional evidence to provide general guidance for prevention and clinical practice, and to foster multidisciplinary collaboration in the management of sleep disorders and …