Publications by Year: 2025

Inflammatory bowel diseases (IBDs) affect millions worldwide, necessitating frequent monitoring of intestinal inflammation to optimize treatment strategies. However, current fecal calprotectin tests have low patient adherence, limiting their utility for inflammation monitoring. Here, we developed an ingestible biosensor for simplified at-home detection of a key inflammation biomarker-reactive oxygen species (ROS). Our pill for ROS-responsive inflammation monitoring (PRIM) employs an ROS-responsive polymer that selectively degrades in the presence of ROS. Degradation triggers the release of blue dye into feces for a visually detectable readout without fecal sampling or laboratory analysis. In vitro, PRIM remained stable under healthy conditions and activated only at elevated ROS levels (10-50 mM H2O2). In rats with colitis, the miniaturized PRIM demonstrated a sensitivity of 78% and a specificity of 72% in detecting intestinal inflammation. With further optimization, PRIM has the potential to improve accessibility and patient adherence to inflammation monitoring and enhance personalized disease management for IBD.

Chronic pain-including both chronic primary pain (e.g., headaches, widespread musculoskeletal pain, abdominal pain) and chronic secondary pain associated with other health conditions-represents a significant yet underrecognized health concern among transgender and gender-diverse (TGD) youth. While data on the prevalence of chronic pain in TGD youth remain limited, early studies indicate higher rates compared to their cisgender peers, highlighting the need for understanding factors underlying this co-occurrence. Chronic pain arises from a complex interplay of neurobiological, psychological, and social factors, and its heightened prevalence in TGD youth may be driven by the compounded impact of biopsychosocial stressors that disproportionately affect this group. This review summarizes neurobiological vulnerabilities, psychosocial factors, and societal and systemic barriers that may contribute to increased risk of chronic pain in TGD youth. We also examine the role of gender-affirming care in addressing these biopsychosocial vulnerabilities and explore its potential to alleviate some of the factors associated with chronic pain. Additionally, we identify critical gaps in the current body of research, such as the need for longitudinal studies and deeper exploration of the effects of medical interventions like pubertal suppression and exogenous hormones on chronic pain mechanisms and outcomes. By synthesizing the available evidence, we aim to guide future research and offer actionable recommendations to enhance clinical care and support for TGD youth experiencing chronic pain.

UNLABELLED: Personality disorders (PD) are common and debilitating psychiatric conditions, often characterized by severe interpersonal and self-dysfunction. Borderline personality disorder (BPD) is the most studied PD, with treatments like Good Psychiatric Management (GPM) demonstrating effectiveness. To address the current state of the personality disorder field, where most evidence-based treatments have been developed using a categorical approach, while the most empirically supported approach is the dimensional one, we developed an adaptation of GPM (GPM-extended) integrating concepts of dimensional personality dysfunction into an established therapeutic framework. This prospective "here-there" study will compare GPM-extended with standard GPM in two outpatient facilities. This methodological choice is due to organizational and institutional limitations. Participants (≥18 years) meeting BPD criteria per the SCID-II will be included. The GPM-extended group incorporates a dimensional diagnostic framework focusing on three personality dilemmas (rejection/abandonment fears, self-esteem dysregulation, and perfection/control issues), with tailored psychoeducation and treatment priorities. The standard GPM group will follow the validated GPM protocol, emphasizing interpersonal hypersensitivity and standard psychoeducation. Both groups will receive weekly individual therapy and group interventions for one year. Between-group differences at 1-year follow-up will be assessed using multiple regression models adjusted for baseline scores. The primary outcome is the change in BPD symptom severity (ZAN-BPD). Secondary outcomes include personality functioning, traits, and various clinical dimensions such as impulsivity, emotional regulation, and social functioning. All patients having initiated the program and having initial data will be included in the analysis, with multiple imputations for missing data and sensitivity analyses planned. Altogether, this study seeks to evaluate the feasibility and efficacy of integrating dimensionality into GPM, offering a pragmatic pathway to improve PD treatment and bridging gaps between evidence-based conceptualizations and treatments of PD.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT06913738.

In the context of the increasing number of health care mergers, bridging institutional cultures is critical to successful outcomes. Using the Massachusetts General Hospital (MGH) and Brigham and Women's Hospital (BWH) as a case study, this article discusses cultural challenges during a 30-year history from an initial merger that only combined corporate and administrative functions (Partners HealthCare) to one that is currently mandating comprehensive clinical integration (renamed Mass General Brigham [MGB]). Although the ultimate success of this strategy will take years to evaluate, the cultures of the old MGH and BWH have not yet been effectively bridged to the new MGB. A thoughtful, sustained investment in bridging these cultural divides could still strengthen alignment and help realize the long-term goals of merging these 2 academic medical centers.

PURPOSE: We compared how transgender and gender diverse (TGD) and cisgender adults in the United States develop age-related chronic conditions and use health care throughout their lives.

METHODS: Using an established algorithm, we identified TGD beneficiaries in Medicare claims data from 2011 to 2020. We identified the 10 nearest-neighbor cisgender matches for each TGD beneficiary based on propensity scores estimated from the original basis of eligibility, years of Medicare enrollment, race, ethnicity, age, and hospital service area. Our primary outcomes were chronic conditions and health care utilization variables as measured by the Chronic Conditions Warehouse. We used generalized estimating equations with a logit link to compare age-related chronic conditions and health utilization between the TGD and matched cisgender cohorts, controlling for original eligibility, years of Medicare enrollment, race, ethnicity, and age. We plotted age-related chronic conditions and health care utilization over age for TGD and cisgender beneficiaries.

RESULTS: We identified 38,187 TGD Medicare beneficiaries. We found that TGD beneficiaries had higher rates of age-related chronic conditions than cisgender beneficiaries. These disparities grew as beneficiaries aged for endocrine and renal conditions, musculoskeletal conditions and chronic pain, and neurological conditions. TGD beneficiaries were more likely to use inpatient, outpatient, emergency department, skilled nursing facility, home health, and dialysis care than cisgender beneficiaries.

CONCLUSION: As the number of TGD-identified adults grows, these findings underscore the need for Medicare to create policies and programs that address the needs of TGD beneficiaries.

BACKGROUND: Germline genetic testing is recommended for patients with prostate cancer, both localized and advanced, based on disease and family history criteria, with results that may inform targeted therapy. However, real-world utilization of germline genetic testing and potential disparities in access remain inadequately characterized. We analyzed germline genetic testing utilization in a national cohort of Medicare beneficiaries with prostate cancer, examining geographic variation and factors associated with testing.

METHODS: Using nationwide Medicare claims (2019-2023), we identified patients with newly diagnosed prostate cancer and germline genetic testing claims. Patient-level geographic patterns of testing rates were evaluated using Rural-Urban Continuum Codes (metropolitan, urban, rural) and hospital referral regions. Using multivariable logistic regression, we assessed associations between residence type and germline genetic testing receipt, adjusted for sociodemographic covariates. The SEER database was used to estimate the proportion of patients meeting clinicopathologic criteria for testing.

RESULTS: Among 749,202 men with prostate cancer, 17,821 (2.38%) underwent germline genetic testing. Based on SEER data, 36.5% of patients would have met clinicopathologic criteria for testing. Across 306 hospital referral regions, testing rates ranged from 0.29% to 14.1%. Urban residents were less likely to undergo germline genetic testing than metropolitan residents (odds ratio [OR], 0.85; 95% CI, 0.75-0.95). Increasing age (≥81 years: OR, 0.54; 95% CI, 0.50-0.58) and Asian ethnicity (OR, 0.69; 95% CI, 0.58-0.82) were associated with a lower odds of germline genetic testing.

CONCLUSIONS: This study reveals substantial underutilization of germline genetic testing among Medicare beneficiaries with prostate cancer. Despite evidence supporting its use and benefits, <3% of patients underwent testing, even though more than one-third met established criteria. These findings underscore the need to improve regional access to testing and increase awareness among patients and physicians, particularly for older and Asian populations.

INTRODUCTION: Disorders of gut-brain interaction (DGBI), including irritable bowel syndrome and functional dyspepsia, are chronic gastrointestinal syndromes characterized by visceral hypersensitivity and altered brain-gut signaling in the absence of known structural pathology. A significant proportion of individuals with DGBI have comorbid psychiatric conditions, especially anxiety and depression, highlighting the biopsychosocial underpinnings of these disorders.

METHODS: This narrative review synthesizes the neurophysiological, psychological, pharmacological, and psychotherapeutic literature related to DGBI. We examined the role of gut-brain axis dysregulation, the prevalence and impact of psychiatric comorbidity, and evaluated current treatment modalities, including neuromodulators, brain-gut behavior therapies (BGBTs), and dietary interventions.

RESULTS: Neuroimaging and genetic studies support the role of emotional and cognitive circuits in modulating gut sensitivity and symptom perception. Psychiatric comorbidity, particularly anxiety, is bidirectionally linked to DGBI and influences treatment response. Neuromodulators such as tricyclic antidepressants demonstrate modest efficacy. BGBTs-including cognitive behavioral therapy and gut-directed hypnotherapy-exhibit comparable efficacy to pharmacologic treatments, with sustained symptom relief and additional benefit on mood and illness-related beliefs.

DISCUSSION: DGBI represent complex, stress-sensitive conditions best managed through multidisciplinary care. Integration of pharmacologic neuromodulation, psychotherapeutic interventions, and dietary strategies targeting the brain-gut axis offers the most comprehensive approach. Future research should refine treatment matching based on symptom phenotype, psychological profile, and gut-brain biomarkers to improve long-term outcomes.

PURPOSE: To examine the influence of patient demographic characteristics and ophthalmic practice composition on access to cataract surgery in the United States as measured by preoperative best-corrected visual acuity (BCVA).

PATIENT AND METHODS: This retrospective cohort study analyzed data from the IRIS® Registry (Intelligent Research in Sight) for patients age >50 who had at least one BCVA measurement in the six months preceding cataract surgery performed between January 1, 2016, and December 31, 2020. We used mixed-effects models to estimate the relationship between individual-level demographic factors and practice-level composition factors and preoperative BCVA.

RESULTS: A total of 2,387,045 individuals met the inclusion criteria. The mean BCVA prior to surgery was 0.23 (SD: 0.32) logMAR. The worst pre-operative BCVA was observed in patients with Hispanic race and ethnicity, while White patients had the best [0.34 (SD: 0.43), 0.21 (SD: 0.30); p<0.001]. Grouping patients in terms of percentage of BCVA worse than 20/50 prior to surgery, Hispanic patients, active smokers, and uninsured patients had higher percentages of worse preoperative vision (33.7%, 23.5%, 34.9%). Analysis of compositional effects of race and ethnicity, smoking, and insurance status showed that, regardless of an individual patient's demographic, patients treated at practices serving higher proportions of White patients showed better BCVA (b = -0.008 per 10 percentage points, P <0.001), while patients at practices with higher percentages of actively smoking patients showed worse BCVA (b=-0.016 per 10 percentage points active smoking patients, P <0.001). There was no compositional effect of insurance status.

CONCLUSIONS AND RELEVANCE: Overall differences exist with regard to the visual acuity at which cataract surgery is initiated at both the level of the individual patient and the composition of the practice in which they are treated.

PURPOSE: The aim of this study was to explore the religious, cultural, and systemic barriers to corneal donation and transplantation in Syria and to propose a context-specific framework for establishing a sustainable eye banking system.

METHODS: We conducted a narrative review incorporating retrospective data from Syria's largest eye hospital and an analysis of Islamic legal opinions related to corneal donation. Key barriers to donation and access to corneal transplantation were identified through thematic synthesis of clinical and religious sources.

RESULTS: Between 1997 and 2025, over 74% of documented cases of corneal pathology requiring transplantation remained untreated because of limited infrastructure, severe shortages in donor tissue, and cultural beliefs. While public hesitancy is driven by concerns over bodily integrity and mistrust in the health system, Islamic jurisprudence overwhelmingly supports corneal donation as a permissible and charitable act.

CONCLUSIONS: Religious alignment and community education present major opportunities for expanding corneal donation in Syria. We propose a framework for sustainable eye banking rooted in operational feasibility, religious endorsement, and public trust.

BACKGROUND: During a medical crisis, emergency physicians often discuss life-saving interventions with seriously ill patients and their families. Crisis conversations require strong communication skills and a patient-centered approach.

OBJECTIVE: To culturally adapt and assess the acceptability of an existing English crisis conversation guide for use by emergency physicians in Thailand.

MATERIALS AND METHODS: A three-stage mixed-method study was conducted. The initial stage included the translation and cultural adaptation of an English crisis conversation guide to Thai using a modified Delphi method with an expert panel's consensus. The expert panel included four emergency physicians and four palliative care clinicians. The second stage involved surveying Thai emergency physicians on the perceived necessity of each step of the conversation guide using a 5-point Likert scale. In the third stage, the expert panel reviewed the survey results and incorporated feedback to produce the final Thai crisis conversation guide.

RESULTS: The Thai crisis conversation guide was initially adapted from the English original via Thai word adaptation and practical rearrangement. In the refinement stage, the expert panel modified several strategies for exploring patient values and added a new step to the conversation guide, which the authors term "gathering the decision makers". The acceptability survey was completed by 180 Thai emergency physicians, with a 36% response rate. These physicians reported that the step with the strongest perceived necessity in the conversation guide was "summarize goal of care" with 176 participants (98%) responding "agree" and "strongly agree".

CONCLUSION: The crisis conversation guide was culturally adapted for clinical practice in Thailand. More than 88% of Thai emergency physicians reported the conversation guide to be acceptable in their clinical practice.