Medical Specialties Commons^™

Multifocal Papillary Thyroid Carcinoma With Ret P.V804m, Eml4-Alk Fusion, And Braf V600e Positivity, Jacob Beiriger, Leonard Estephan, Lubna Zuberi, Stacey Gargano, Elizabeth Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Multifocal papillary thyroid cancer (PTC) can arise from independent primaries with discordant drivers in parallel clonal evolution rather than a single-clone pattern. We present a 31-year-old female with multifocal PTC harboring 3 distinct oncogenic alterations: a germline RET p.V804M mutation, low-frequency EML4-ALK fusion, and BRAF V600E mutation. The RET and ALK alterations were identified in a midpole nodule, whereas BRAF positivity was seen in a separate lower pole tumor. Ultrasound revealed multiple right-lobe thyroid nodules; the dominant 2.1-cm lesion was hypoechoic with calcifications. Fine needle aspiration revealed Bethesda III cytology, prompting thyroid lobectomy and an ipsilateral central neck dissection was …

Inhibition Of Cyclophilin D Rescues Cardiac Function And Bioenergetic Defects Caused By Neonatal Hypoxia, Jonathan R. Burris, Gisela Beutner, Min Yee, Bartholomew V. Simon, Michael F. Swartz, Kathryn B. Boudreau, Ethan D. Cohen, Chaitanya A. Kulkarni, Prottoy Hasan, Hongyue Wang, Karen L. De Mesy Bentley, György Hajnóczky, George M. Alfieris, Eric M. Small, Paul S. Brookes, Michael A. O'Reilly, George A. Porter

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Increased oxygen levels at birth regulate myocyte bioenergetic and structural maturation controlled by mitochondrial cyclophilin D (CypD). We evaluated mechanisms of neonatal hypoxic cardiac dysfunction by exposing neonatal mice to 12% oxygen and studied cardiac bioenergetics, myocyte maturation, and function. Hypoxia decreased the activity/assembly of electron transport chain complex I, uncoupled oxidative phosphorylation, increased proliferation, decreased differentiation, increased ventricular mass, and decreased cardiac function. CypD inhibition rescued most hypoxia-mediated effects and increased cardiac function. In conclusion, neonatal hypoxia alters cardiac bioenergetics, myocyte maturation, and cardiac function through CypD-dependent pathways, providing potential therapeutic targets for neonatal cardiac dysfunction.

Speed Of Intravenous Fluid On Glycocalyx Integrity And Central Blood Volume In A Porcine Septic Shock Model, Yosef Levenbrown, Md Jobayer Hossain, Paul T. Fawcett, Marjorie Postell, Anne M. Hesek, Lynell S. Jones, James P. Keith, Thomas H. Shaffer

Department of Pediatrics Faculty Papers

BACKGROUND: It is unclear whether the rate of intravenous fluid (IVF) administration in sepsis influences glycocalyx breakdown. This study aimed to measure the effect of rapid versus slow fluid bolus in a septic pig model on the integrity of the glycocalyx by measuring the serum levels of heparan sulfate and syndecan-1, breakdown products of the glycocalyx. Because endothelial glycocalyx is composed of apical cell membrane-bound proteoglycans such as syndecan-1, covalently bound with long linear glycosaminoglycans such as heparan sulfate, shedding of these different glycocalyx components is closely related. Additionally, we measured central blood volume (blood volume in the heart and …

Sudden Cardiac Arrest & Newly Diagnosed Arrhythmogenic Cardiomyopathy In A High School Athlete, Jacob Rolfes, Brent Holtgrewe, Mike Tzianos

2026 Student Academic Showcase

A high school soccer player experienced sudden cardiac arrest during competition and required immediate CPR and AED use. Following resuscitation, physicians ruled out commotio cordis and identified findings consistent with arrhythmogenic cardiomyopathy, supported by a prolonged T-wave on EKG while all other laboratory and catheterization results were normal. The athlete later received an ICD and pacemaker, prompting significant physical, emotional, and lifestyle adjustments. This capstone project examines the emergency response, the role of trained medical personnel at sporting events, and the implications of early cardiac screening for adolescent athletes. Through consented family interviews, structured questionnaires, and case-based data collection, the …

Longitudinal Fueling Status Of High School Female Athletes, Kaylee Turner, Abigail Rickermann

2026 Student Academic Showcase

Low energy availability (LEA) is a clinically significant concern in adolescent female athletes due to its impact on growth and development, bone health, hormonal function, performance, recovery, and cognitive outcomes. Despite established associations, a clear longitudinal understanding of how LEA relates to injury and illness rates across an academic year remains limited, representing a clinical gap in athletic training and sports medicine literature. The purpose of this capstone project was to develop a comprehensive Institutional Review Board (IRB) protocol to support a future longitudinal investigation examining LEA and its relationship to injury and illness incidence in high school female athletes. …

Effectiveness Of Rule Modification And Contact Exposure Reduction In Adolescent Contact Sports, Alex Martin

2026 Student Academic Showcase

Clinical Question: In adolescent athletes participating in contact sports, does rule modification or contact restriction reduce sport-related concussion incidence compared with standard full-contact rules? Background: Sport-related concussion remains a major concern in youth athletics. Structural prevention strategies, such as limiting contact exposure, have been proposed as effective approaches, though their comparative effectiveness remains under review. Methods: A critically appraised topic (CAT) was conducted using Google Scholar to identify peer-reviewed studies from the past 15 years examining rule modification or contact restriction as primary prevention strategies. Six high-quality studies met inclusion criteria, including one meta-analysis, one systematic review, prospective cohort studies, …

Clinical Evaluation And Rehabilitation Of A Complex Non-Contact Knee Injury In A Collegiate Athlete, Shelby Pritt

2026 Student Academic Showcase

This case follows the rehabilitation of a 22-year-old collegiate lacrosse player recovering from a complex knee injury. During the initial evaluation, the athlete presented with pain, swelling, and limited active range of motion, secondary to pain. The rehabilitation protocol used a combination of ACL, MCL, and meniscus standardized rehabilitation parameters. The primary goal of rehabilitation was to safely return the athlete play the following season. This case highlights the importance of knee health and the role of preventative exercise programs in reducing injury risks. This case covers the rehabilitation of a complex right knee injury primarily focusing on a complete …

Glp-1 Receptor Agonists In Diabetic Foot And Ankle Care: Skeletal Liability Or A Blessing In Disguise? A Scoping Review, Daniela Lizbeth Avilez, Amanda Killeen

School of Podiatric Medicine - Student Research

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for glycemic control and weight reduction in patients with Type 2 Diabetes Mellitus (T2DM). Patients with T2DM exhibit elevated fracture risk despite preserved bone mineral density due to impaired bone quality and microarchitectural compromise. Whether GLP-1 RA therapy exacerbates or mitigates skeletal risk remains clinically relevant to podiatric care.

Hypothesis: We hypothesized that GLP-1 RA therapy is not associated with increased lower extremity fracture risk and may demonstrate protective trends influenced by age and duration of therapy.

Methods: A review of PubMed and Google Scholar (2010–2026) was conducted. Inclusion criteria …

Optimization Of Pediatric Multidetector Ct Imaging Parameters Using A Machine Learning–Based Monte Carlo Simulation Model, Ali O. Masoud, Adithya Rajnaryanan, Khamis O. Amour, Ahmed M. Jusabani, Justin E Ngaile, Manoj Kumar, Mwingereza John Kumwenda Dr

Tanzania Journal of Science

This study utilized Monte Carlo (MC) simulations to optimize radiation doses in pediatric multidetector computed tomography (MDCT) head scans by analyzing key parameters like tube current (mA), tube voltage (kV), pitch, and slice thickness. The findings indicate that reducing tube current significantly lowers the Computed Tomography Dose Index (CTDIvol) and Dose Length Product (DLP), effectively minimizing patient radiation exposure. Higher pitch values (0.7–0.9) further reduced radiation by decreasing beam overlap, while using a thinner slice thickness (0.6 mm) improved dose efficiency. A comparison highlighted the effectiveness of optimization: simulated parameters kVp 100, mAs 81, pitch 0.98 yielded a CTDIvol of …

Improving Pneumococcal Immunization Counseling In Children With Systemic Lupus Erythematous, Sarah Dettmann

Doctoral Dissertations & Projects

Background: Pediatric patients with systemic lupus erythematosus (SLE) face elevated risk for invasive pneumococcal disease, yet fewer than 10% are estimated to be current on pneumococcal vaccine (PCV) recommendations.

Local Problem: This quality improvement (QI) project aimed to develop and implement a standardized pneumococcal immunization screening and counseling process in a pediatric rheumatology clinic.

Method: Three consecutive PDSA cycles guided implemention across a nine-week intervention period using a pre-post quasi-experimental design.

Interventions: A multicomponent strategy was employed, including a PCV decision algorithm, EHR Smart Phrase, PCP referral template, and patient education brochure.

Results: Pre-implementation PCV counseling was documented …

Seeing Surgery Differently: The Role Of Virtual Reality In Pediatric Care, Bob Underwood, Mark Ryan

Pediatrics in Practice: A CME Podcast

Virtual reality is changing how pediatric surgeons plan procedures, educate care teams and help children and families better understand what to expect. In this episode, Mark Ryan, MD, pediatric surgeon, discusses how virtual reality is being used in pediatric surgery today, its impact on patient experience and surgical planning and what pediatricians should know as this technology continues to evolve.

Click here to stream the podcast episode.

Muc13-Associated Molecular Interactome In Pancreatic Cancer, Anupam Dhasmana, Swati Dhasmana, Rajasekhar Baru, Abigail Gomez, Shafiul Haque, Sheema Khan, Murali Yallapu, Subhash Chauhan

School of Medicine Publications

Mucin-13 (MUC13) has emerged as a critical molecular player involved in tumorigenesis, cancer progression, metastasis, and evasion of immune surveillance, including in pancreatic cancer. In this report, we identified MUC13 molecular interactome using an integrated immunoprecipitation and liquid chromatography–mass spectrometry (accession no. of protein data JPST004189) approach combined with systems network biology to determine its plausible functional protein–protein interaction network and associated oncogenic mechanisms. This study reveals a total of 54 key MUC13 interactor proteins (including cyclin-dependent kinase 1, catenin delta 1, Caludin-1, ErbB3-binding protein 1, basic transcription factor 3, tight junction protein 1, etc.). Interestingly, the majority of these …

Lessons Learned From A Sustained Mobile Prenatal Care Delivery Program: Results From A Mixed-Methods Evaluation To Understand Appointment Attendance And Patient Satisfaction., Stacey Cunnington, Candice Mims, Rebecca Barbeau, Sonia Booker, Mary Ann Abiado, Gain Robinson, Salina Tesfay, Cintia Ulloa-Hays, Donna Beach, Nimo Farah, Eleanor Porter, Rebecca Rudel, Jacey A Greece

Women’s Health Articles

No abstract provided.

Psychological Safety In Health Care: A Prerequisite For High Reliability, Sonali Thosani

Advances in Cancer Education and Quality Improvement

This paper presents a viewpoint on how psychological safety contributes to patient safety, teamwork, and high reliability.

Kobayashi Maru, Daniel Mahoney

Advances in Cancer Education and Quality Improvement

This poem invites the reader to consider the uncertainty of facing an unwinnable situation. Kobayashi Maru is a reference to a fictional leadership test from Star Trek, designed to confront participants with a no-win scenario. While the test is famously “beaten” by the show’s hero, this piece aspires to depict the often unwinnable circumstance of caring for a child with incurable illness. The reader is provided space to consider how the balance of emotions and values may shift when read through the eyes of a parent, clinician, or observer.

The Weight Of The White Coat, Jonathan Cunningham

Advances in Cancer Education and Quality Improvement

This is a poem reflecting on the mission of the medical provider through the image of the white coat.

Beyond Boundaries: A Model For Boosting Staff Retention And Morale Through Career Mobility, Tiffany Hughes, Abigail Caudle, Robert Ghafar, Brandon Freudensprung, Paloma Vasquez

Advances in Cancer Education and Quality Improvement

Retention and morale in health care are strategic imperatives that directly influence patient care, quality outcomes and operational stability. At The University of Texas MD Anderson Cancer Center, we found a significant gap in the career advancement opportunities for our clinical and administrative staff. Employees lacked visibility into career growth pathways, leaving them disengaged and increasing the overall turnover rate. In response, our division launched a structured, transparent Career Mobility Model to provide employees with the clarity and tools needed for advancement. This model integrates career mapping, shadowing programs, and leader-led career conversations, all of which led to measurable gains …

Clinical Medical Emergency Team Training Simulation (Cmetts): An Interprofessional Simulation For Medical Students And Nursing Residents, Allan John R. Barcena, Marvin R. Bernardino, Dominic Karl M. Bolinas, Kitz Paul D. Marco, Toni Edwards, Shelita Kimble, James Cavalier, Marites P. Melancon, Jillian R. Gunther

Advances in Cancer Education and Quality Improvement

Effective teamwork and communication are critical during medical emergencies, particularly in oncology, yet health care professionals are often trained separately, creating challenges for interprofessional collaboration. Evidence-based frameworks like Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) offer structured tools to optimize team performance. This study describes a simulation-based program, the Clinical Medical Emergency Team Training Simulation (CMETTS), designed to instill foundational teamwork skills in early-stage learners. First-year medical students and newly graduated nursing residents participated in an interprofessional simulation involving medical emergency scenarios followed by structured debriefing sessions guided by TeamSTEPPS principles. We evaluated the program’s effectiveness …

Lessons Learned For Improving Trainee Engagement And Utilization Of Education And Training Materials For Cancer Research, Katerina M. Santiago, Tania Galindo, Michaela A. Dinan

Advances in Cancer Education and Quality Improvement

Background: A core component of the National Cancer Institute Cancer (NCI) Cancer Center Support Grant requires cancer centers to coordinate research career enhancement and related activities. The Yale Cancer Center, an NCI-designated comprehensive cancer center, established the Cancer Research Training and Education Coordination (CRTEC) component in 2016. In response to the needs of trainees, CRTEC has developed several initiatives that we have identified and described here as best practices to engage and support trainees.

Methods: We had 2 aims to improve engagement: 1) increasing our visibility and trainee awareness of CRTEC and nurturing bidirectional communication and 2) offering …

Centralizing Communication Intake To Improve Workflow Visibility And Engagement: A Quality Improvement Project In A Cancer Center's Education Division, Menatalla El-Sharkawi, Mohamed Ait Aiss

Advances in Cancer Education and Quality Improvement

Background: In large or complex organizations, multiple teams may be charged with managing different components of a project, initiative, or administrative assignment. When these teams have overlapping needs for information, the absence of a structured intake and tracking process can limit transparency, reduce efficiency, and hinder coordination across communication channels.

Methods: Drawing on principles of strategic communications and project management, we created a structured and centralized information sharing process for teams within the education division of a comprehensive cancer center. The intervention included workflow redesign, development of a standardized intake system, and use of real-time dashboard analytics to support operation …

Icu Decision Tool Impact On Rebound Hyperglycemia, Daniel J. Donovan, Emily Highsmith, Sonya Khan, Michelle Horng

Advances in Cancer Education and Quality Improvement

Hyperglycemia, defined as a blood glucose level ≥180 mg/dL in the hospitalized patient, is linked to negative outcomes including longer hospital stays, increased infection risk, and higher morbidity and mortality rates. In addition to critically ill patients with diabetes, hyperglycemia can develop in individuals without diabetes due to factors such as steroid use, continuous tube feedings, and an elevated stress response. Patients who have uncontrolled hyperglycemia are often placed on continuous insulin infusions (CII), but rebound hyperglycemia frequently occurs after CII discontinuation if the maintenance insulin regimen (MIR) is insufficient. Implementation of a MIR decision support tool integrated within an …

Genetic Predispositions To Cancer: What Pediatricians Need To Know, Sarah Gubara, Nicole Wood

Pediatrics in Practice: A CME Podcast

Pediatric hematology/oncology physician Nikki Wood, DO, explains how pediatricians can recognize genetic cancer risk, refer to genetics appropriately, and support families through long‑term surveillance.

Click here to stream the podcast episode.

Pharmacologic Interventions To Reduce Cardiopulmonary Bypass Induced Inflammation In Cardiac Surgery: A Scoping Review, Wyatt Anderson

Student Works

ABSTRACT

1. Structured summary

Background

Cardiopulmonary bypass (CPB) is essential in cardiac surgery but can trigger a systemic inflammatory response that contributes to postoperative complications. The scoping review conducted has a purpose to map the existing literature on pharmacologic interventions to mitigate CPB related inflammation. While several interventions demonstrated potential anti-inflammatory effects, findings were inconsistent, and no standardized pharmacologic approach is currently agreed upon.

Methods

This scoping review followed PRISMA-ScR guidelines.Both PubMed, and CINAHL were screened for studies published between 2000 and 2024 that evaluated pharmacologic interventions aimed at reducing CPB related inflammation. After screening and duplicate removal, 10 studies met …

Biomechanical Effects Of Bilateral Torsion And Skeletal Fusion: A Case Study, Linnéa Forbes

Honors Projects

As part of both a personal endeavor and an academic project, I have investigated the aetiology and treatment of seemingly idiopathic and debilitating leg pain in a patient over the past 10 years. Via collaboration with medical professionals at Cincinnati Children’s Hospital, Cincinnati Premier Physical Therapy, and Cincinnati Women’s TriHealth, I have identified sources of pain at the anatomical level. The combination of internal femoral torsion, external tibial torsion, pes planus, and bony fusions appear to be major perpetuators of the pain. An effective treatment continues to be evasive. To date, I have attempted to find answers through genetic approaches, …

Out-Of-Pocket Costs And Antihypertensive Medication Use Among Veterans: A Natural Experiment, Alexander R. Zheutlin, Alexander Chaitoff, Daniel Addo, Joshua A. Jacobs, Catherine G. Derington, Eric L. Stulberg, Peter A. Glynn, Bernardo Modenesi, Jordana B. Cohen, Adam P. Bress

Department of Neurology Faculty Papers

BACKGROUND: Blood pressure (BP) control remains suboptimal in the United States despite available low-cost antihypertensive medications. Even small out-of-pocket medication costs may contribute to adherence. We determined whether $0 versus >$0 out-of-pocket costs for antihypertensive medications is associated with differences in adherence, discontinuation, BP control, and cardiovascular outcomes.

METHODS: We included veterans with newly diagnosed hypertension who initiated antihypertensive medication in the Veterans Health Administration from 2004 to 2022. A fuzzy regression discontinuity design with 2-stage residual inclusion leveraged differences in medication copay policy at a 50% service-connected disability threshold (≥50% service-connected disability: $0 out-of-pocket cost versus < 50%: $8 monthly cost). Outcomes included 1-year medication nonadherence (proportion of days covered < 80%), 1-year medication discontinuation (no medication in the final 90 days of the study year), 1-year BP control (systolic BP/diastolic BP < 140/90 mm Hg and < 130/80 mm Hg) and cardiovascular disease events (myocardial infarction, coronary revascularization, peripheral artery disease, or stroke).

RESULTS: Among 417 …

Deep Learning And Experimental Validation Of Brca1-Associated Protein-1 Missense Variant Pathogenicity In Uveal Melanoma, Nikhil Davé, David J. Taylor Gonzalez, Mak B. Djulbegovic, Linda A. Cernichiaro-Espinosa, Benjamin A. King, Carol L. Shields, Matthew W. Wilson

Wills Eye Hospital Papers

OBJECTIVE: To benchmark the pathogenicity predictions of AlphaMissense, a deep learning model, against high-throughput functional scores from saturation genome editing (SGE) for all experimentally tested BRCA1-associated protein-1 (BAP1) missense variants in uveal melanoma (UM).

DESIGN: Cross-sectional analytical study comparing computational predictions with experimentally derived functional classifications and clinical annotations.

SUBJECTS PARTICIPANTS AND/OR CONTROLS:  ClusteredAll 4619 BAP1 single amino acid substitutions profiled in a published Regularly Interspaced Short Palindromic Repeats-Cas9 SGE viability assay. No separate control cohort was required. Clinical Variant Database (ClinVar)-annotated variants within this set served as an independent reference.

METHODS: Saturation genome editing log₂-fitness …

Cardiovascular Disease And Dyslipidemia In Pediatric Type 1 Diabetes, Grace K Kim, Preneet Cheema Brar, Nidhi Bansal

Faculty, Staff and Students Publications

Purpose of review

Despite advances in type 1 diabetes (T1D) management, mortality is still increased, with cardiovascular disease (CVD) as the leading cause. Dyslipidemia is a highly prevalent modifiable CVD risk factor. We reviewed the existing literature on CVD mortality in T1D to highlight CVD risk in pediatric patients with T1D.

Recent findings

Pathophysiology of T1D and premature CVD risk is still not fully understood. Dyslipidemia remains a highly prevalent and undertreated CV risk factor in T1D. Statins have been shown to be safe and effective to improve CVD risk in adults with T1D, and in children with familial hypercholesterolemia, …

Quantifying Sleep Wake Rhythms In The Hospital Environment With Digital Technologies, Carsten Skarke, Nadim El Jamal, Michael V. Genuardi, Thomas G. Brooks, Antonijo Mrčela, Nicholas F. Lahens, Makayla Cordoza, Sean Sarles, Amarachi Mbadugha, Dineth R. Karunamuni, Shikhar Gupta, Charles J. Bae, Amita Sehgal, Thomas P. Cappola, Jacob T. Gutsche, Pavan Atluri, Nimesh D. Desai, Michael A. Acker, Gregory R. Grant, Richard J. Schwab, Ilene M. Rosen, Garret A. Fitzgerald

Division of Cardiology Faculty Papers

Postoperative clinical care is prone to circadian desynchronization that may influence health outcomes. In an exploratory, feasibility-oriented and signal-exploration effort, we collected 1.8 million data points using 11 remote sensors during preoperative, in-hospital and post-discharge settings in 13 elective cardiac surgery patients (5.2% enrolled from 252 screened). We found that room traffic continued during nighttime with ≥1 visit/h. Sound levels exceeded the recommended 45 dBA threshold (51.9 ± 3.3 vs. 48.3 ± 4.2 dBA during nighttime). Brightness dropped at night (89.9 ± 87.7 to 3.7 ± 9.8 lux), but bright light exposures occurred. Ambient room temperature lacked sleep-inducing diurnal variability. …

Examining Racial And Ethnic Differences In Quality Of Care Between Home And In-Center Hemodialysis, Sukhman Bains

2026 Symposium

Home hemodialysis (HHD) offers improved flexibility and clinical outcomes compared to in-center hemodialysis. However, its use remains limited, particularly among racial and ethnic minority populations disproportionately affected by end-stage renal disease (ESRD). This systematic review analyzed seven retrospective cohort studies (2004–2025) to assess disparities in HHD utilization and outcomes. Minority patients were significantly less likely to initiate HHD, with adjusted odds ratios ranging from 0.45 to 0.70, while no disparities were observed within Canada’s universal healthcare system. Although HHD was associated with lower mortality, this finding is likely influenced by selection bias, as HHD patients tended to be younger and …

Transforming Patient Safety And Care Practices Through Interprofessional Education, Kaleena Ramirez, Claudia C. Tamara, Jennifer Sells, Karen Clatt, Banan Abuharb, Mary Coolbaugh-Murphy, Iris Culwell, Anca Fumurescu, Mary Gust, Lori Simmons, Delores Whiteing, Annie Koenig, Sara Martinez, Wilton Muriithi, Shaun T. Caldwell, Susan Lee, Mary Sizemore, Kimberly Ann H. Krumwiede

Advances in Cancer Education and Quality Improvement

As healthcare increasingly relies on interdisciplinary teams to deliver safe and effective care, the development of interprofessional collaboration competencies among students in health care professions has become an educational priority. In response, The University of Texas MD Anderson Cancer Center School of Health Professions integrated a longitudinal interprofessional education curriculum to foster collaborative practice readiness and prepare students for team-based interdisciplinary environments that ensure safe and patient-centered care. The curriculum was guided by the Interprofessional Education Collaborative 2016 and 2023 core competencies for interprofessional collaborative practice, reinforced with the Real Colors® Personality Instrument and Team Strategies and Tools to Enhance …