Medical Specialties Commons^™

Comparison Of Injuries Sustained On Grass And Artificial Turf By Usl1 Men’S Soccer Team. Part 1: Match Related Injuries, Michael Osterholt, Jason Meredith, Jenenne A. Geske

Posters and Presentations: Family Medicine

No abstract provided.

Photophobia Is Associated With Lower Sleep Quality In Individuals With Migraine: Results From The American Registry For Migraine Research (Armr), Nina Sharp, Mark J Burish, Kathleen B Digre, Jessica Ailani, Mahya Fani, Sophia Lamp, Todd J Schwedt

Faculty, Staff and Student Publications

BACKGROUND: Patients with migraine often have poor sleep quality between and during migraine attacks. Furthermore, extensive research has identified photophobia as the most common and most bothersome symptom in individuals with migraine, second only to headache. Seeking the comfort of darkness is a common strategy for managing pain during an attack and preventing its recurrence between episodes. Given the well-established effects of daily light exposure on circadian activity rhythms and sleep quality, this study aimed to investigate the relationship between photophobia symptoms and sleep quality in a cohort of patients with migraine.

METHODS: A cross-sectional observational study was conducted using …

Serum Neuroactive Metabolites Of The Tryptophan Pathway In Patients With Acute Phase Of Affective Disorders, Yanli Li, Leilei Wang, Junchao Huang, Ping Zhang, Yanfang Zhou, Jinghui Tong, Wenjin Chen, Mengzhuang Gou, Baopeng Tian, Wei Li, Xingguang Luo, Li Tian, L Elliot Hong, Chiang-Shan R Li, Yunlong Tan

Faculty, Staff and Student Publications

BACKGROUND: Many studies showed disrupted tryptophan metabolism in patients with affective disorders. The aims of this study were to explore the differences in the metabolites of tryptophan pathway (TP) and the relationships between TP metabolites and clinical symptoms, therapeutic effect in patients with bipolar disorder with acute manic episode (BD-M), depressive episode (BD-D) and major depressive disorder (MDD).

METHODS: Patients with BD-M (n=52) and BD-D (n=39), MDD (n=48) and healthy controls (HCs, n=49) were enrolled. The serum neuroactive metabolites levels of the TP were measured by liquid chromatography-tandem mass spectrometry. Hamilton Depression Scale-17 item (HAMD-17) and Young Mania Rating Scale …

Phase 1b Study Of Intraperitoneal Ipilimumab And Nivolumab In Patients With Recurrent Gynecologic Malignancies With Peritoneal Carcinomatosis, Anne Knisely, Emily Hinchcliff, Bryan Fellman, Ann Mosley, Kathryn Lito, Sara Hull, Shannon N Westin, Anil K Sood, Kathleen M Schmeler, Jolyn S Taylor, Steven Y Huang, Rahul A Sheth, Karen H Lu, Amir A Jazaeri

Faculty, Staff and Student Publications

Background: Intravenous immune checkpoint blockade (ICB) has shown poor response rates in recurrent gynecologic malignancies. Intraperitoneal (i.p.) ICB may result in enhanced T cell activation and anti-tumor immunity.

Methods: In this phase 1b study, registered at Clinical.

Trials: gov (NCT03508570), initial cohorts received i.p. nivolumab monotherapy, and subsequent cohorts received combination i.p. nivolumab every 2 weeks and i.p. ipilimumab every 6 weeks, guided by a Bayesian design. The primary objective was determination of the recommended phase 2 dose (RP2D) of the combination. Secondary outcomes included toxicity, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS).

Findings: …

Combined Deletion Of Men1, Atrx And Pten Triggers Development Of High-Grade Pancreatic Neuroendocrine Tumors In Mice, Mary Esmeralda Fuentes, Xiaoyin Lu, Natasha M Flores, Simone Hausmann, Pawel K Mazur

Faculty, Staff and Student Publications

Pancreatic neuroendocrine tumors (PanNETs) are a heterogeneous group of tumors that exhibit an unpredictable and broad spectrum of clinical presentations and biological aggressiveness. Surgical resection is still the only curative therapeutic option for localized PanNET, but the majority of patients are diagnosed at an advanced and metastatic stage with limited therapeutic options. Key factors limiting the development of new therapeutics are the extensive heterogeneity of PanNETs and the lack of appropriate clinically relevant models. In that context, genomic sequencing of human PanNETs revealed recurrent mutations and structural alterations in several tumor suppressors. Here, we demonstrated that combined loss of MEN1, …

Coronary Microvascular Dysfunction In Childhood: An Emerging Pathological Entity And Its Clinical Implications, Takeshi Tsuda, Gina Patel

Department of Pediatrics Faculty Papers

Coronary microvascular dysfunction (CMD) encompasses a spectrum of structural and functional alterations in coronary microvasculature resulting in impaired coronary blood flow and consequent myocardial ischemia without obstruction in epicardial coronary artery. The pathogenesis of CMD is complex involving both functional and structural alteration in the coronary microcirculation. In adults, CMD is predominantly discussed in context with anginal chest pain or existing ischemic heart disease and its risk factors. The presence of CMD suggests increased risk of adverse cardiovascular events independent of coronary atherosclerosis. Coronary microvascular dysfunction is also known in children but is rarely recognized due to paucity of concommitent …

Gaza War: Too Many Citizens Being Killed, Sheraz Yaqub, Bjørn Edwin, Zane Hammoud, Gabriel Herrera-Almario, Buthaina Jabir, Kristoffer Lassen, Pål Dag Line, Miguel Angel Lopez-Gonzalez, Michael Puttick, Mohammed Ahmed Idrees Saadelnour, José Sampaio-Neto, Raghuram Sampath, Konstantin V. Sementsov, Ajith K. Siriwardena, Ernesto Sparrelid, Alberto Büge Stein, Robert Sutcliffe, Helena Taflin, Hany Takla, Silvio Valdec, Cherisse N. Vinoya, Waleed Zaid, Stephen J. Wigmore

School of Dentistry Faculty Publications

No abstract provided.

Storylines Of Family Medicine Xii: Family Medicine And The Healthcare System, Kurt C. Stange

Faculty Scholarship

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'XII: Family medicine and the future of the healthcare system', authors address the following themes: 'Leadership in family medicine', 'Becoming an academic family physician', 'Advocare-our call to act', 'The paradox of primary care and three simple rules', 'The quadruple aim-melding the patient and the health system', 'Fit-for-purpose medical workforce', 'Universal healthcare-coverage for all', 'The futures of family medicine' and …

Influence Of Rna Circularity On Target Rna-Directed Microrna Degradation, Federico Fuchs Wightman, Jerónimo Lukin, Sebastián A Giusti, Michael Soutschek, Laureano Bragado, Berta Pozzi, María L Pierelli, Paula González, Juan P Fededa, Gerhard Schratt, Rina Fujiwara, Jeremy E Wilusz, Damián Refojo, Manuel De La Mata

Faculty, Staff and Students Publications

A subset of circular RNAs (circRNAs) and linear RNAs have been proposed to 'sponge' or block microRNA activity. Additionally, certain RNAs induce microRNA destruction through the process of Target RNA-Directed MicroRNA Degradation (TDMD), but whether both linear and circular transcripts are equivalent in driving TDMD is unknown. Here, we studied whether circular/linear topology of endogenous and artificial RNA targets affects TDMD. Consistent with previous knowledge that Cdr1as (ciRS-7) circular RNA protects miR-7 from Cyrano-mediated TDMD, we demonstrate that depletion of Cdr1as reduces miR-7 abundance. In contrast, overexpression of an artificial linear version of Cdr1as drives miR-7 degradation. Using plasmids that …

Structural Basis Of Dna Crossover Capture By Escherichia Coli Dna Gyrase, Marlène Vayssières, Nils Marechal, Long Yun, Brian Lopez Duran, Naveen Kumar Murugasamy, Jonathan M Fogg, Lynn Zechiedrich, Marc Nadal, Valérie Lamour

Faculty, Staff and Students Publications

DNA supercoiling must be precisely regulated by topoisomerases to prevent DNA entanglement. The interaction of type IIA DNA topoisomerases with two DNA molecules, enabling the transport of one duplex through the transient double-stranded break of the other, remains elusive owing to structures derived solely from single linear duplex DNAs lacking topological constraints. Using cryo–electron microscopy, we solved the structure of Escherichia coli DNA gyrase bound to a negatively supercoiled minicircle DNA. We show how DNA gyrase captures a DNA crossover, revealing both conserved molecular grooves that accommodate the DNA helices. Together with molecular tweezer experiments, the structure shows that the …

Storylines Of Family Medicine Xii: Family Medicine And The Healthcare System, William B Ventres, Leslie A Stone, Jeannette E South-Paul, Kendall M Campbell, Aerial R Petty, Hima Ekanadham, Kurt C Stange, Rebecca S Etz, William L Miller, Robert L Ferrer, Marianna Kong, Thomas Bodenheimer, Roger Strasser, Sharon C M Reece, Joshua Freeman, John M Westfall

Faculty, Staff and Students Publications

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘XII: Family medicine and the future of the healthcare system’, authors address the following themes: ‘Leadership in family medicine’, ‘Becoming an academic family physician’, ‘Advocare—our call to act’, ‘The paradox of primary care and three simple rules’, ‘The quadruple aim—melding the patient and the health system’, ‘Fit-for-purpose medical workforce’, ‘Universal healthcare—coverage for all’, ‘The futures of family …

Water, Sanitation, And Hygiene Infrastructure And Resources In Schools In Belize During The Covid-19 Pandemic, 2021-2023, Anh N Ly, Kelsey Mcdavid, Christina Craig, Dian Maheia, Yolanda Gongora, Alexandra Medley, Francis Morey, Russell Manzanero, Gerhaldine Morazan, Allison Lino, Vickie Romero, Rosalva Blanco, Kanako Ishida, Matthew Lozier, Kristy O Murray

Faculty, Staff and Students Publications

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental …

Akap12 Upregulation Associates With Pde8a To Accelerate Cardiac Dysfunction, Hanan Qasim, Mehrdad Rajaei, Ying Xu, Arfaxad Reyes-Alcaraz, Hala Y Abdelnasser, M David Stewart, Satadru K Lahiri, Xander H T Wehrens, Bradley K Mcconnell

Faculty, Staff and Students Publications

BACKGROUND: In heart failure, signaling downstream the β2-adrenergic receptor is critical. Sympathetic stimulation of β2-adrenergic receptor alters cAMP (cyclic adenosine 3',5'-monophosphate) and triggers PKA (protein kinase A)-dependent phosphorylation of proteins that regulate cardiac function. cAMP levels are regulated in part by PDEs (phosphodiesterases). Several AKAPs (A kinase anchoring proteins) regulate cardiac function and are proposed as targets for precise pharmacology. AKAP12 is expressed in the heart and has been reported to directly bind β2-adrenergic receptor, PKA, and PDE4D. However, its roles in cardiac function are unclear.

METHODS: cAMP accumulation in real time downstream of the β2-adrenergic receptor was detected for …

Miniature Battery-Free Epidural Cortical Stimulators, Joshua E Woods, Amanda L Singer, Fatima Alrashdan, Wendy Tan, Chunfeng Tan, Sunil A Sheth, Sameer A Sheth, Jacob T Robinson

Faculty, Staff and Student Publications

Miniaturized neuromodulation systems could improve the safety and reduce the invasiveness of bioelectronic neuromodulation. However, as implantable bioelectronic devices are made smaller, it becomes difficult to store enough power for long-term operation in batteries. Here, we present a battery-free epidural cortical stimulator that is only 9 millimeters in width yet can safely receive enough wireless power using magnetoelectric antennas to deliver 14.5-volt stimulation bursts, which enables it to stimulate cortical activity on-demand through the dura. The device has digitally programmable stimulation output and centimeter-scale alignment tolerances when powered by an external transmitter. We demonstrate that this device has enough power …

Restoring Effective Sleep Time In Post Cardiac Surgery Patients: A Quality Improvement Project, Brooke Watts Bsn, Rn

Epsilon Sigma at-Large Research Conference

Purpose: Restoring Effective Sleep Time in Post Cardiac Surgery Patients: A Quality Improvement Project

Brooke Watts, BSN, RN, DNP Student, Murray State University

Dr. Kristin Reid, DNP, APRN, ACNS-BC, DNP Program Director/Assistant Professor Murray State University

Aims: This quality improvement project was developed using DNP project guidelines provided through Murray State University and was designed to improve sleep in hospitalized cardiac surgery patients.

Processes: IRB approval was obtained from the healthcare institution and academic institution. This two-phase quality improvement project was designed to analyze the effects of a change in normalized hospital routines on self-reported sleep in post-cardiac surgery patients. …

Cavernous Wonders: Delving Into Cavernous Sinus Syndrome In Neuro-Ophthalmology, Anza Rizvi, Ba

inSIGHT

Cavernous sinus syndrome (CSS) is any disease process that affects the cavernous sinus. This syndrome is marked by a complex interplay of neurovascular symptoms, primarily due to the compression or dysfunction of the cranial nerves that traverse the cavernous sinus. Understanding the intricate details of this syndrome is critical to providing optimal care and improving patient outcomes.

Seeing Clearly: A Bright Future With Light Adjustable Intraocular Lenses For Presbyopia, Shady Mina, Bs

inSIGHT

Presbyopia, or the age-related decline in the ability to focus on near objects, is a common vision disorder that affects 1.8 billion people globally, with this number expected to increase to 2.1 billion by 2030.^1-4 A diminished accommodation response is the primary cause of presbyopia.¹ The eye has a very complex accommodation mechanism that permits people to distinctly see objects from various distances.^1,3 Even though the precise mechanism of accommodation is yet to be determined, the current evidence strongly supports Helmholtz’s theory, which claims that the thickness and curvature of the eye’s lens increase while its diameter …

Medical Missions, Ethical Considerations And The Future For Healthcare Delivery In Ophthalmology, Robert Medina, Ba

inSIGHT

Beginning hundreds of years ago, priests from Europe embarked on ‘medical missions’ with the goals of delivering care to the body, mind, and soul. Hundreds of years later, members of the United States healthcare system set out on humanitarian medical missions to provide medical assistance to communities in developing countries.¹ The concept of providing care internationally as a product of global social responsibility has become engrained in the United States healthcare system, and is popular among providers, trainees, and pre-medical students. In 2023, 21.8% (n = 3264) of matriculating medical students reported participating in international volunteer work, while 7.0% …

Chronic Progressive External Ophthalmoplegia, Bahram Pashaee, Mph, Bs

inSIGHT

Chronic progressive external ophthalmoplegia is an inherited or sporadic form of dystrophy that preferentially affects the extraocular muscles of the eye. While this dystrophy can manifest systemically, the extraocular muscles are commonly involved due to their constant metabolic demands and vulnerability to oxidative stress.¹ This preferential involvement of the eyelid levator muscle and extraocular muscles makes CPEO an important condition to consider in a differential diagnosis for eyelid asymmetry and double vision among other conditions such as myasthenia gravis, thyroid-associated ophthalmoplegia, and other mitochondrial myopathies.² This dystrophy tends to occur in the third or fourth decade of life. …

Macular Holes: Diagnosis, Treatment, And Complications, Ayra Khan, Bs

inSIGHT

Macular hole is a condition that affects the central visual field of the eye. Without prompt diagnosis and intervention, macular holes can progressively worsen, significantly impacting both vision and overall quality of life.

Cmv Retinitis: An Expert’S Perspective, Caitlyn Kwun, Ba

inSIGHT

Uveitis is a rare inflammatory disease with a prevalence of around 38 per 100,000 people and is the overall 5th leading cause of blindness in the developed world.^1,2 Uveitis is most commonly found in patients younger than 40 years of age, but it can occur in any age group with an etiology that varies within each age demographic.^1,3 While the etiology of certain forms of uveitis are not fully understood, there are some that are autoimmune in nature and others that are associated with systemic diseases such as sarcoidosis.⁴ Uveitis may be inflammatory or infectious. It may …

Bridging The Global Gap Of Blindness Through Artificial Intelligence - Exploring The Tools Of Ai To Address The Top Causes Of Blindness In Under-Resourced Communities Worldwide, Nathan Delacth, Bs

inSIGHT

Technological advancements have allowed us to submerge in a sea of innovation and excellence in medicine. Electronic health records transformed the healthcare landscape, improving portability of patient information while streamlining communication and fostering collaboration.¹ Imaging technologies, such as magnetic resonance imaging (MRI) and Optical computed tomography (OCT), granted us the ability to view internal structures using non-invasive methods. In a similar vein, artificial intelligence (AI) has emerged as an impactful force in various fields of medicine, and its influence on ophthalmology is no exception.

Evolution Of Lamellar Keratoplasty, Ishan Kasat, Bs

inSIGHT

Overview of Keratoplasty The evolution of corneal transplantation, or keratoplasty, has seen a paradigm shift from traditional penetrating keratoplasty (PKP) to the refined precision of lamellar keratoplasty (LK). Penetrating, or full thickness, keratoplasty is a replacement of all corneal layers: epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium.¹ Lamellar, or partial thickness, keratoplasty involves replacement of either epithelium and stroma (anterior lamellar) or Descemet’s membrane and endothelium (posterior lamellar).² From 1985 to 2004, over 95% of graft tissues were used for PKP. However, from 2005 to 2014, the percentage of PKP procedures decreased from 95% to 42%, while …

The Myopia Epidemic: Exploring The Pathology And Management Of The World’S Most Common Eye Disorder, Gabriella Baldassarre, Bs

inSIGHT

Myopia is the most common eye disorder in the world and an increasing cause of vision impairment in children.¹ Myopia is an imbalance in the refractive components of the eye and its length, leading to inaccurate focusing of light rays in front of the retina tissue instead of on it. There is a spectrum of severity of myopia, from mild nearsightedness to a more severe form known as high or degenerative myopia, which has the potential to cause vision loss and blindness. There is evidence of a developing myopia epidemic, with an estimated one-third of the world population affected …

Insight, Volume 4, Issue 1, 2024

inSIGHT

Contents

8 - The Myopia Epidemic: Exploring the Pathology and Management of the World’s Most Common Eye Disorder
By Gabriella Baldassare

15 - Evolution of Lamellar Keratoplasty
By Ishan Kasat

19 - Bridging the Global Gap of Blindness Through Artificial Intelligence
By Nathan Delacth

24 - CMV Retinitis: An Expert’s Perspective
By Caitlyn Kwun

29 - Macular Holes: Diagnosis, Treatment, and Complications
By Ayra Khan

36 - Chronic Progressive External Ophthalmoplegia
By Bahram Pashaee

39 - Medical Missions, Ethical Considerations, and the Future for Healthcare Delivery in Ophthalmology
By Robert Medina

43 - Shaping the Future of Vision: The Rise …

Enhancing Nsclc Recurrence Prediction With Pet/Ct Habitat Imaging, Ctdna, And Integrative Radiogenomics-Blood Insights, Sheeba J Sujit, Muhammad Aminu, Tatiana V Karpinets, Pingjun Chen, Maliazurina B Saad, Morteza Salehjahromi, John D Boom, Mohamed Qayati, James M George, Haley Allen, Mara B Antonoff, Lingzhi Hong, Xin Hu, Simon Heeke, Hai T Tran, Xiuning Le, Yasir Y Elamin, Mehmet Altan, Natalie I Vokes, Ajay Sheshadri, Julie Lin, Jianhua Zhang, Yang Lu, Carmen Behrens, Myrna C B Godoy, Carol C Wu, Joe Y Chang, Caroline Chung, David A Jaffray, Ignacio I Wistuba, J Jack Lee, Ara A Vaporciyan, Don L Gibbons, John Heymach, Jianjun Zhang, Tina Cascone, Jia Wu

Faculty, Staff and Student Publications

While we recognize the prognostic importance of clinicopathological measures and circulating tumor DNA (ctDNA), the independent contribution of quantitative image markers to prognosis in non-small cell lung cancer (NSCLC) remains underexplored. In our multi-institutional study of 394 NSCLC patients, we utilize pre-treatment computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to establish a habitat imaging framework for assessing regional heterogeneity within individual tumors. This framework identifies three PET/CT subtypes, which maintain prognostic value after adjusting for clinicopathologic risk factors including tumor volume. Additionally, these subtypes complement ctDNA in predicting disease recurrence. Radiogenomics analysis unveil the molecular underpinnings of these …

Shared Genomic Segments Analysis Identifies Mhc Class I And Class Iii Molecules As Genetic Risk Factors For Juvenile Idiopathic Arthritis, Cecile N. Avery, Nicole D. Russell, Cody J. Steely, Aimee O. Hersh, John F. Bohnsack, Sampath Prahalad, Lynn B. Jorde

Markey Cancer Center Faculty Publications

Juvenile idiopathic arthritis (JIA) is a complex rheumatic disease encompassing several clinically defined subtypes of varying severity. The etiology of JIA remains largely unknown, but genome-wide association studies (GWASs) have identified up to 22 genes associated with JIA susceptibility, including a well-established association with HLA-DRB1. Continued investigation of heritable risk factors has been hindered by disease heterogeneity and low disease prevalence. In this study, we utilized shared genomic segments (SGS) analysis on whole-genome sequencing of 40 cases from 12 multi-generational pedigrees significantly enriched for JIA. Subsets of cases are connected by a common ancestor in large extended pedigrees, increasing the …

Risk Factors For Failure Of Same-Day Discharge Total Knee Arthroplasty, Kevin X. Farley, Robert S. Dean, Eli Auch, Mark Karadsheh, Drew Moore

Conference Presentation Abstracts

OBJECTIVE: Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA and (2) if there are differences in early complications between cemented and uncemented TKA. METHODS: We retrospectively reviewed data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database of primary TKA patients from 2017 to 2021 at a single health system (six hospitals). Uncemented TKA (uncemented fixation for femur and tibia) patients were analyzed for demographics and …

National Incidence And Economic Burden Of Revision Shoulder Arthroplasty In The United States: Projections Through 2030, Kevin X. Farley, Robert S. Dean, Eric R. Wagner, Michael B. Gottschalk, J Michael Wiater

Conference Presentation Abstracts

PURPOSE: This study sought to use an all-payor inpatient claims database to investigate the incidence and national cumulative costs of revision shoulder arthroplasty in the United States, including those being performed for PJI. In addition, we also aimed to project the incidence and national economic impact of revision shoulder arthroplasty in the US through 2030. METHODS: The National Inpatient Sample (NIS) was used to estimate the annual number of revision shoulder arthroplasties performed between 2008 and 2019 using ICD procedure codes. Cumulative national costs were estimated. Septic revision shoulder arthroplasties were identified (i.e., cases being done for a prosthetic joint …

‘Joining The Dots: Linking Prenatal Drug Exposure To Childhood And Adolescence’ – Research Protocol Of A Population Cohort Study, Kate Lawler, Mithilesh Dronavalli, Andrew Page, Evelyn Lee, Hannah Uebel, Barbara Bajuk, Lucinda Burns, Michelle Dickson, Charles Green, Lauren Dicair, John Eastwood, Ju Lee Oei

Faculty, Staff and Student Publications

INTRODUCTION: Prenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The

METHODS AND ANALYSIS: Information from routinely collected administrative databases was linked for all births registered in New South Wales (NSW), Australia between 1 July 2001 and 31 December 2020 (n=1 834 550). Outcomes for seven mutually exclusive groups of children with varying prenatal exposure to maternal substances of addiction, including smoking, alcohol, prescription/illicit drugs and neonatal abstinence syndrome will be assessed. Key exposure measures include maternal drug use type, maternal …